Washington Watch: Struggling to Legislate: Lame Duck Session May Offer Only Chance for 2012 Legislative Progress

Published Monday, June 25, 2012
by Marjorie Vanderbilt, AAGP Deputy Executive Director & Director of Government Affairs

The 112th Congress is finding it hard to do what used to seem so easy: the sharp divisions within and between the Republican and Democratic Parties in both the Senate and the House of Representatives have stifled the agendas of both political parties in this election year and left lawmakers to work on below-the-radar and modest, if not minor, pieces of legislation.

The other factor that has and will continue to stifle legislative progress in this election year is the amount of time that lawmakers are not in Washington but are in their districts for so-called “Constituent Work Weeks” (i.e., campaign time). As of May 8th, House members have been working just 41 of the first 127 days of 2012, and the current schedule has them away from Capitol Hill for 17 of the year’s remaining 34 weeks. And, even when the House is in session, the typical workweek is only three days.

The Second Session of the 112th Congress has very few achievements to point to, to date--among them, patent reform and aid for trade-displaced workers. A few other issues are likely to move before November--including some Fiscal Year 2013 appropriations measures, cybersecurity legislation, reform of the postal system, and another extension of the highway bill. However, these bills hardly compare to the welfare overhaul, increase in the minimum wage and expanded access to health care that the last Democratic president, Bill Clinton, and a Republican Congress accomplished in the 1996 presidential and congressional election year.

The 112th Congress ushered in a new legislative reality. One difference between 1996 and 2012 is that the Republican Party is now emboldened by the influx of tea partyers who joined their ranks following the 2010 election and are determined to give as much power as possible to the states--directly challenging the role of the Federal Government. Meanwhile, the old way of winning votes from reluctant lawmakers by funding pet projects in their home states and districts has become a thing of the past, scuttled by increasing deficits and a ban on such “earmarks”. Gone are the days when bills were loaded with provisions that directly aided lawmakers’ pet projects, thereby swelling support for a major piece of legislation.

One example of the legislative gridlock is the transportation bill. In the past, transportation bills always enjoyed strong, bipartisan support, as improving roads was politically popular and those bills were a vehicle for numerous earmarks to sweeten the pot for reluctant lawmakers. In March of this year, the Democratic-controlled Senate, in a rare moment of bipartisan cooperation, overwhelmingly approved a $109 billion, two year bill to fund roads, bridges, bike paths and subway systems, while creating hundreds of thousands of jobs. However, in the Republican-led House, Republicans were unable to obtain majority support for their own five-year $260 billion transportation bill. House Speaker John Boehner (R-OH), facing a revolt by the rank and file, had to pull the bill before it got to the House floor for a vote. Tea Partyers said that $260 billion was too much money; Republicans from urban areas were upset by the bill’s treatment of transit funding; and some moderates opposed paying for the House plan with expanded oil drilling. The House Republican Leadership was unable to corral enough votes to pass a long-term reauthorization of surface transportation programs, prior to the late March expiration date for those programs. Consequently, lawmakers were pressured to do something fast so that Federal highway and transit project spending did not dry up when the authorization expired on March 31. And so, Congress once again did exactly what they said they did not want to do, but have done so often recently--a 90-day extension of authorization for highway, transit and safety programs was passed in order to give key players more time to hammer out a long-term plan acceptable to both the House and the Senate.

Looking down the road for the rest of this year, there are major issues looming that need to be resolved to avert falling back into another recession. In less than eight months, the Bush-era tax rates are scheduled to expire, increasing rates for the middle class as well as top income wage earners. At the same time, automatic Federal spending cuts will kick in. That combination, coupled with the expiration of the payroll tax cut, other expiring tax provisions and perhaps even a hike in the debt ceiling, could constitute a major blow to economic recovery. All of those “big-ticket” items--the expiring Bush-era tax rates, budget sequestration (automatic budget cuts), an increase in the debt ceiling, and an approximate 30 percent cut in Medicare payments to physicians--will have to be dealt with by December 31. Faced with that scenario, one would assume that both parties should have an incentive to reach a deal to avert disaster. However, no one in Washington really believes that an agreement on any of those issues will come together until an expected lame duck session after the November elections. Votes on any and all politically tough issues are unlikely during this campaign season. So, November and December may well be the busiest work period of 2012. And at that point, there will only be a few weeks to cobble together a deal in a lame duck session--possibly postponing any big decisions until 2013.

With the highly controversial budget cuts and tax policy decisions being pushed off until after the election, some worry that there simply will not be enough time to address the Medicare physician fee schedule during the lame duck session. During that session, there will only be about 20 working days for Congress to address all the issues on the table--no small task for a Congress where bipartisanship is rare. The issue on staving off the 30 percent cut to Medicare providers is not whether or not it should be done but how to pay for it under current budget conditions. If the cuts are not addressed before time runs out, Medicare claims would be frozen as they were in 2010 when the same debate occurred over how to pay the bill for extending rates. The ideal solution to the fee schedule problem would be a permanent fix; however, many are just hoping that Congress will be able to at least avert the cuts for another year.

It should be noted that lame duck sessions of Congress are a vestige of the “old days,” when transportation delays made it hard for members of Congress to gather in a timely fashion after an election. Now, they are used as an excuse to avoid the wrath of voters prior to an election.

In 2011--the First Session of the 112th Congress--the House passed 384 bills, and the Senate passed 402 bills. Of those totals, just 56 House bills and only 24 Senate bills were enacted into law. Will the Second Session of the 112th Congress do better than that? Probably not.

One-Quarter of Eligible Professionals Participated in 2010 Quality Reporting

On March 30, the Centers for Medicare and Medicaid Services (CMS) reported that about a quarter (26 percent) of the approximately one million professionals eligible for the Physician Quality Reporting System (PQRS) participated in the program in 2010. The number of participants, 268,968, was up from a total of 210,559 participants in 2009, according to a report, 2010 Reporting Experience Including Trends (2007-2011), Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Program.

PQRS allows physicians and other eligible professionals to earn incentive payments for reporting quality-related information about the services they provide to Medicare beneficiaries, such as the percentage of women who receive mammograms. Among those participating, 72 percent were eligible for incentives, compared with 57.3 percent in 2009, according to the report.

Incentive payments in 2010 totaled $392 million, of which $364 million was earned by individual eligible professionals. In 2009, $237 million was earned by individual professionals. Other professionals participated as part of groups.

Under the 2010 electronic prescribing (eRx) incentive program, 18.8 percent of the 696,663 professionals who were eligible participated, compared with 13.4 percent in 2009, according to the report. Under this program, participants report their use of a qualified electronic prescribing system during an eligible visit with a Medicare beneficiary.

Of those professionals who submitted data on the eRx measures in 2010, 63.3 percent were incentive eligible, as compared to 53.9 percent in 2009. In 2010, eRx incentive payments totaled $271 million, compared with $148 million in 2009.

Physician specialties with the highest participation rates in 2010 were cardiology (35.4 percent) and ophthalmology (33.8 percent), which was similar to the rates in 2009. In 2009, the specialty with the largest percentage of eligible participants was ophthalmology (19.2 percent).

Providers and Hospitals Registered for Incentives

Approximately 20,000 eligible professionals and hospitals registered for the Medicare and Medicaid electronic health record incentive programs in February of this year, bringing the total to more than 211,600 since January 2011, when registration began, according to a March 29 incentive program update from the Centers for Medicare and Medicaid Services (CMS).

Overall, more than 62,000 eligible professionals, eligible hospitals, and critical access hospitals have been paid over $3.8 billion for successfully participating in the Electronic Health Records (EHR) Incentive Programs, CMS said. Over $738 million was paid in the month of February alone, according to the agency.

CMS Releases Chapter on Incentive Payments

On March 23, the Centers for Medicare and Medicaid Services (CMS) released a new third chapter to its Medicare Quality Reporting Incentive Programs Manual on incentive payments for providers under the Physician Quality Reporting System and the electronic prescribing program. The chapter describes the yearly payment instructions to be used by Medicare contractors when making the payments. According to the CMS transmittal (Change Request 7727), it “manualizes existing requirements to the programs” but does not establish new requirements.

The transmittal contains an “incentive payment results report” that is to include such data as the number of checks paid. It is available at www.cms.gov/transmittals/downloads/R5QRI.pdf.

CMS Proposed Rule Would Move ICD-10 Compliance Date to 2014

On April 9, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that would delay the compliance date for the International Classification of Diseases, 10th Revision (ICD-10) code set from October 1, 2013, until October 1, 2014. The ICD-10 delay was influenced in part by concerns from providers over their ability to meet the 2013 compliance date, according to the proposed rule which was published in the April 17 Federal Register.

The ICD-10 delay originally was announced on February 16 by Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, who said the department was committed to working with the provider community to come up with a new compliance date.

In a release, CMS said that ICD-10 “will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes.”

“Since publication of the ICD-10 and Modifications final rules, a number of other statutory initiatives were enacted, requiring health care provider compliance and reporting. Providers are concerned about their ability to expend limited resources to implement and participate in … initiatives that all have similar compliance timeframes,” according to the proposed rule.

In addition to ICD-10, providers are working to implement electronic health record (EHR) technology to comply with the Medicare and Medicaid EHR Incentive Program requirements, as well as comply with electronic prescribing requirements under the Medicare eRx Incentive Program.

CMS considered extending the ICD-10 delay until October 2015, but determined it would place too much financial burden on organizations that were expected to be ICD-10 compliant by the original 2013 date. CMS also said it was concerned that a two-year delay would lead to organizations abandoning ICD-10 implementation efforts.

Pursuing a Permanent Payment Patch

In early May, it began to appear that both the House and Senate were starting to focus seriously on the Medicare physician payment issue. For almost a decade, Congress has overridden the reduction in payment rates dictated by the Sustainable Growth Rate, a 1997 formula designed to keep Medicare costs under control. However, lawmakers have never come up with a way to resolve the problem on a permanent basis. It now appears that they have started to have serious discussions about possible solutions in a way that they haven’t before.

On May 9, Reps. Allyson Schwartz (D-PA) and Joe Heck (R-NV) introduced legislation to get rid of the SGR and begin a series of demonstration programs to develop new payment models that could replace it. (See related article in this column.)

On May 10, the Senate Finance Committee brought in four former Medicare chiefs to brainstorm ideas for how to do away the ongoing reimbursement program. The meeting included Thomas Scully, who served as CMS administrator under President George W. Bush; Gail Wilensky, who led the agency under President George H.W. Bush; Bruce Vladek, who led the agency under President Clinton; and Mack McClellan, who led CMS under President George W. Bush. Sen. Orrin Hatch (R-UT), the senior Republican on the committee, said that despite the bipartisan support to repeal the formula, “a solution has eluded the Congress up to this particular point.” That can be blamed on two things. First, the Congressional Budget Office estimated the cost of repealing the formula at approximately $316 billion over ten years. Second--and this is where members of Congress are now focusing their attention--there is no consensus on how to replace the system.

The SGR formula was put into place as part of a balanced budget proposal to help curb the growth rate of Medicare spending. The formula calls for automatic cuts in Medicare’s reimbursement rates for providers when the growth rate of provider costs exceeds the growth rate of the economy. Beginning in 2002, the formula has called for cuts. Congress allowed the first cuts to take place, but since then, lawmakers have given in to provider protests and blocked the reductions. Instead, they went for short-term payment patches, known as the “doc fix.” The current patch expires at the end of this year.

If Congress continues with temporary fixes, instituting a replacement will only become harder. Every time Congress blocks the cuts, it increases the cost of getting rid of the formula, because Medicare savings have never been realized. That means that with every new fix, Congress must pay for the cost of the increased payment rates as well as make up for the missed savings and postponed rate reductions.

At the Senate Finance Committee meeting, Committee Chairman Max Baucus (D-MT) asked the former Medicare directors to send him, by mid-June, short- and long-term suggestions on ways to handle physician payments. He said that he felt that there was a consensus to repeal the formula, put in place stable but temporary payment rates, and then gradually move to new payment models. That is the model promoted in the Schwartz-Heck legislation. However, Baucus did not commit to a timetable for introducing legislation incorporating those ideas.

The former administrators told the committee that the current system has to be replaced because it does not accurately reflect the practice of medicine by many physicians, particularly those in small group practices, and rewards physicians for providing more, but not necessarily better, care. They told lawmakers not to repeal the current system without putting some type of mechanism in place that will act to control spending, as does the SGR formula.

In early May, the House Ways and Means Committee reached out to a number of physician groups, including AAGP, and asked them to offer ideas and share experiences about enhancing care delivery, as part of the committee’s efforts to change the SGR formula.

The letter, which was signed by Committee Chairman Dave Camp (R-MI) and Subcommittee on Health Chairman Wally Herger (R-CA) broke its queries into three categories:

  • Rewarding Quality and Efficiency: The groups were asked about their use of quality and outcome measures, including utilizing such tools as electronic health records and patient registries;
  • Alternative Payment Methods: The groups were asked to share their experiences with alternative methods, such as bundled payments and shared saving models; and
  • Patient Involvement and Regulatory Relief: The groups were asked for advice about encouraging beneficiaries to seek appropriate care and asked whether any regulatory burdens stand in the way of helping patients.

The letter said that input from the medical community would be useful in the quest for a solution to the SGR problem, particularly because of activities undertaken by medical groups, such as collecting data on clinical performance and developing programs on “care delivery transformation.”

“Medicare spending is on an unsustainable path, and we must find a better way to reward you for the quality of care delivered,” the letter concluded.

Bill Introduced to Repeal Medicare Physician Payment System

On May 9, Reps. Allyson Schwartz (D-PA) and Joseph Heck (R-NV) introduced H.R. 5707, the Medicare Physician Payment Innovation Act, which would repeal Medicare’s physician payment system and provide a transition to a new payment system, paid for by using unspent funds from the wars in Afghanistan and Iraq.

H.R. 5707 would repeal the sustainable growth rate (SGR) formula and maintain 2012 physician payment levels through 2013. That would be followed by a four-year transition to a system in which physician payments would be increased 0.5 percent annually before a new system would be implemented in 2018. The bill would require the Centers for Medicare and Medicaid Services (CMS) to test and evaluate possible new payment systems through a series of demonstration projects. By 2017, physicians would choose from at least four delivery and payment models identified by CMS.

Congress has grappled for about a decade with how to prevent Medicare’s physician payment system from annually cutting reimbursement to physicians. It has intervened numerous times to cancel physician reimbursement cuts, and it will have to do so again to avoid a 30 percent pay cut due to be implemented on January 1, 2013.

Although many lawmakers and stakeholders, including AAGP and the American Medical Association (AMA), favor a permanent fix, the high cost of implementing one has prevented Congress from taking action. Adopting a permanent fix could cost more than $300 billion over ten years.

“For too long we failed America’s seniors and created a long-term fiscal nightmare for Medicare by maintaining the status quo of the broken Medicare physician payment system,” Schwartz said in a press release. “Now is the time to fix the broken system once and for all by moving forward with a payment system that rewards quality and value, saves lives, and assures seniors’ access to the care they need.”

Heck said, “The current sustainable growth rate formula has consistently produced unrealistic spending targets, which have threatened access to care for our seniors. Congress has addressed the issue by providing temporary reimbursement patches that have left our Medicare providers wondering if they will be able to continue seeing patients. This bill replaces the flawed sustainable growth rate used for physician reimbursements, providing long-overdue certainty for physicians, and ensuring that Medicare beneficiaries have access to their physicians.”

The idea of using unspent war funds to pay for a physician payment fix has been discussed recently, but has consistently faced opposition from some Republicans. However, Representatives Schwartz and Heck both believe that H.R. 5707 could win support in both parties.

H.R. 5707 has been referred to both the House Energy and Commerce Committee and the House Ways and Means Committee.

Senate Approves Bill To Strike “Lunatic” From Federal Law

On May 23, the Senate unanimously approved S. 2367, the 21st Century Language Act of 2012, which would remove the use of the word “lunatic” from wherever it appears in Federal code. The word “lunatic” appears in the U.S. Code in Title 1, Chapter 1, which covers rules of construction. It also appears in banking law provisions that deal with the authority to take receivership of estates. The bill was approved by the Senate without any amendments.

S. 2367 was introduced in the Senate on April 25 by Sens. Kent Conrad (D-ND) and Mike Crapo (R-ID). Conrad said that he considered sponsorship of the bill after a constituent contacted his office to encourage legislation to remove such “outdated and inappropriate language” from Federal law. In addition, Conrad said that the elimination of “lunatic” from Federal law would help reduce the stigmatization of such conditions.

The legislation has received support from the Mental Health Liaison Group, a national coalition of approximately 40 groups--including AAGP--representing advocates, professionals, providers, and consumers. “The legislation shines a spotlight that these references have no place in Federal law and reflects a more contemporary and deeper understanding of mental health conditions,” the group wrote in an April 3 letter to Senator Conrad. In the letter, the group also said that, “Stigma contributes to the wide treatment gap whereby two-thirds of adults who need mental health treatment don’t get it, and a staggering 80 percent of young people who need treatment, don’t get it. Deleting these terms from usage in the U.S. Code is a simple means of demonstrating respect for individuals living with mental health conditions and will have no effect on the underlying Federal laws.”

Companion legislation has not yet been introduced in the House of Representatives.

Senators Urge CMS to Clarify Sunshine Act Requirements in Final Rule

On April 4, the Senate authors of the Physician Payment Sunshine Act urged the Centers for Medicare and Medicaid Services (CMS) to issue a final rule governing the law by June, so that data collection can begin this year. In a letter to CMS, Sens. Herb Kohl (D-WI) and Charles Grassley (R-IA) said the final rule governing the law should clarify several issues raised in the proposed rule released by the agency in late 2011, including the inclusion of a more precise definition of payment categories “so that all stakeholders are operating under the same assumptions.”

The sunshine law was included in the health care reform law and requires public disclosure of the financial relationships between physicians and the pharmaceutical, medical device, and biologics industries.

Kohl and Grassley also urged CMS to define more clearly the instances when indirect research payments to third parties are reportable and how and within what context these payments will be reported on the public website associated with the law to be run by the agency.

In addition, Kohl and Grassley urged CMS to update the website as soon as it becomes aware of inaccuracies, rather than once a calendar year, as it has proposed. The website should be user friendly to allow the public to determine what payments received by physicians are for, they added. “Research transfers are often vitally important to the development of new therapies and technologies, but without context, a patient could find a large sum of money attached to his/her physician and not know what that funding provided,” the letter said.

CMS should also increase outreach to physicians, many of whom are not aware of the law, Kohl and Grassley said.

The lawmakers asked CMS if it will be able to issue a final rule by June and whether the agency has a dedicated working group to oversee implementation of the law. They requested a meeting with CMS staff on implementation issues.

On May 3, despite pressure from lawmakers, CMS announced it will delay implementing the Physician Payments Sunshine Act and will not begin collecting data until 2013. CMS said it is delaying collecting data from drug and medical device manufacturers “to provide time for organizations to prepare for data submission and to sufficiently address the important input we received during the rulemaking process.”

Companies would have to begin disclosing all physician payment data 90 days after a final rule is published. The proposed rule was published in the December 19, 2011 Federal Register. CMS Acting Administrator Marilyn Tavenner said that the agency has received more than 300 comments on the proposal from a wide range of stakeholders. She said that while CMS recognizes the importance of starting the collection of reporting data as soon as possible, the agency does not believe it will be possible to begin data collection in 2012.

HHS Reorganizes Offices for Aging, Disabled Into New Administration for Community Living

On April 16, the Department of Health and Human Services (HHS) announced that it is consolidating three departmental agencies focused on older adults and people with disabilities into a new Administration for Community Living. The new agency will house HHS’s existing Administration on Aging, Office on Disability, and Administration on Developmental Disabilities. “The new entity will establish a formal infrastructure to ensure consistency and coordination in community living policy across the Federal Government,” HHS said in a press release.

Announcing the new agency, HHS Secretary Kathleen Sebelius said, “The Obama Administration and my department have long been committed to promoting community living and finding new mechanisms to help ensure that the support people with disabilities and seniors need to live in the community are accessible.”

Heading the new agency will be Kathy Greenlee, the current HHS assistant secretary for aging. Henry Claypool, currently director of the Office on Disability, will become principal deputy administrator of the Administration for Community Living. In their new positions, both Greenlee and Claypool will continue to carry out their current responsibilities as well, HHS said.

The new agency will work with the Centers for Medicare and Medicaid Services (CMS) “to develop, refine, and strengthen policies that promote independent living among all populations, especially those served by Medicaid,” HHS said. The Administration for Community Living also will work with CMS to promote home and community-based services and supports.

The reorganizations will not require new legislation or new appropriations language, HHS said, adding that “some adjustments to existing appropriations language could help ease the transition to this new structure.”

For more information about the Administration for Community Living, go to www.hhs.gov/acl/about.html.

Medicare and Social Security Funds Headed for Shortfalls

On April 23, the 2012 Annual Report of the Board of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance was released. In that report on the financial state of Medicare, the trustees for the Medicare and Social Security programs warned that both programs are on a fast track to deep fiscal problems. The Medicare Trust Fund will be “exhausted” (meaning it won’t have enough money on hand to cover the benefits that it is supposed to provide by 2024, according to the Trustees. That is the same time frame anticipated in a report last year. Social Security will reach that tipping point in 2033, three years earlier than predicted last year.

The trustees called on Congress to repair the two entitlement programs quickly, saying that a prompt approach would leave more options on the table and allow lawmakers to make changes gradually.

However, even at the trustees’ press conference, the deep political divisions over Medicare were on full display. Treasury Secretary Timothy Geithner took a pre-emptive shot at Republican-led proposals to partially privatize Medicare. “Adjustments to Social Security and Medicare must be balanced and even-handed,” Geithner said. “We will not support proposals that sow the seeds of their destruction in the name of reform, or that shift the cost of health care to seniors in order to sustain tax cuts for the most fortunate Americans.”

Many Republicans, including presidential candidate Mitt Romney, want to convert Medicare into subsidies to help older adults buy private insurance. Following the trustees’ announcement, Romney’s campaign said that the trustees’ report shows that President Obama doesn’t have a serious plan to tackle entitlement spending. “Today’s report reminds us that Medicare must be reformed and strengthened or it will soon collapse,” Romney’s policy director Lanbee Chen said in a statement. “It also reminds us that President Obama continues to play shell games with the health care of our seniors, taking hundreds of billions from Medicare to spend on ObamaCare and now using a bogus experiment to conceal the damage until after the election.”

The trustees don’t expect the Medicare and Social Security Trust Funds to be empty in 2024 and 2033. Rather, at those dates, the funds would not have enough money on hand to cover the benefits they’re supposed to provide, so some reductions would be inevitable.

The Social Security Trust Fund would be able to pay approximately 75 percent of its benefits after 2033, the Trustees said. The Medicare Trust Fund would be able to pay approximately 87 percent of its costs in 2024. The Medicare Trust Fund only pays for certain benefits, primarily those for hospital stays. Services such as doctors’ visits and prescription drugs are paid for separately, and those funds don’t come from a dedicated account like the trust fund for hospital coverage.

The Trustees’ Report also explains that current legislation leaves physicians facing a nearly 30 percent cut in Medicare payments beginning on January 1, 2013. That cut would come after a decade of nearly frozen payment rates, during which time the cost to care for patients has increased.  The cut will take effect unless Congress takes action to prevent it.

CMS Issues Final Rule Requiring Providers To Obtain National Provider Identifier Number

All providers and suppliers who qualify for a National Provider Identifier (NPI) number will be required to include the NPI on any enrollment applications to Medicare and Medicaid, as well as on any payment claims, according to a final rule issued by the Centers for Medicare and Medicaid Services (CMS) on April 24. CMS said that the rule will save Medicare approximately $1.6 billion over ten years.

The rule also requires physicians and other professionals who are permitted to order and certify covered items and services for Medicare beneficiaries to be enrolled in Medicare. In addition, it mandates document retention and provision requirements on providers and suppliers that order and certify items and services for Medicare beneficiaries.

CMS may revoke a provider’s enrollment in Federal health programs for up to a year for failing to meet the documentation requirements. The agency said most providers that want to enroll in Medicare and Medicaid already have an NPI.

The NPI is a ten digit number that identifies health care providers. The National Plan and Provider Enumeration System collects identifying information on health care providers and assigns each a unique NPI.

SAMSHA Releases Mental Health United States, 2010 Report

On April 25, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a new report, Mental Health United States, 2010. This report includes mental health statistics at the national and state levels from 35 different data sources. The report is organized into People, Providers and Payers sections, and provides a comprehensive compilation of information regarding behavioral health services delivery in the United States, including national-level statistical information on trends in both private and public sector behavioral health services, costs, and clients.

Drawing on diverse data sources, this publication also includes state-level data and information on the mental health needs and services utilization of special populations, such as children, military families, nursing home residents, and incarcerated individuals.

For more information, visit www.samhsa.gov/data/2k12/MHUS2010/index.aspx.


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