Home > About Us > 2016 TCA Year in Review

Throughout 2016, TCA continued to solidify its role as a respected and knowledgeable resource on treatment and SUD policy on Capitol Hill, within the Administration, federal agencies and among other national organizations.  TCA recognizes as part of its mission the importance of educating policymakers and other stakeholders on the need to expand access to evidence-based comprehensive addiction and co-occurring treatment that is based on the full continuum of care.  This was a landmark year for TCA and the field, considering the introduction of legislation specifically advanced by TCA on the IMD Exclusion and action taken by Congress on historic legislation regarding SUD treatment.  Over the past year TCA has developed effective public policy initiatives with an aggressive agenda of public policy activities to promote the mission of TCA and its members on behalf of their clients and others in need of treatment.

 Protecting and Advancing Policy Interests

  • TCA continued to advance stand-alone legislation for repeal of the Medicaid IMD Exclusion as it relates to SUD treatment, working extensively with Congressman Alcee Hastings (D-FL) and his staff on the issue. As a result, Rep. Hastings introduced H.R. 5837 in July 2016, with TCA assisting in efforts to secure cosponsors for the legislation.  TCA issued a call to action for TCA members to urge cosponsorship and sought cosponsors during advocacy days on Capitol Hill in July and October.
  • TCA engaged extensively with Senator Dick Durbin (D-IL) and his staff regarding his bill S. 2605, the Medicaid CARE Act. 2605 would expand access to SUD treatment by modifying the existing Medicaid IMD Exclusion to allow payments for certain residential treatment facilities to treat individuals with substance use disorders and to provide extended duration of residential treatment to pregnant women.  Senator Durbin’s staff were receptive and offered to work with TCA to address our concerns with the 40 bed limit in the proposed bill and requested additional data on TCA programs that would inform decisions about improving the bill.  Related to the legislation, TCA also educated and mobilized its members to secure sign-ons for the Durbin/Collins letter to the Centers for Medicare and Medicaid Services to use existing authorities to broaden treatment opportunities, such as by removing SUD treatment and facilities from the IMD Exclusion.  A bipartisan group of 29 Senators signed onto the letter sent in August 2016.
  • In 2016, Congressional interest in responding to the opioid epidemic continued to build, with extensive debates on treatment for SUD in committees and on the floor of the House and Senate and the passage and enactment of legislation that seeks to expand access to treatment for SUD and mental health services. TCA monitored and reported on a series of hearings and mark-ups on opioids and heroin in the House Energy and Commerce Committee, with direct jurisdiction over health policy related to treatment, as well as additional hearings in the House Judiciary Committee, the House Oversight and Government Reform Committee, and the Senate Health, Education, Labor and Pensions Committee.  TCA engaged Members serving on these panels and their staff, proactively contacting them in advance of the hearings with suggested questions that would shine a spotlight on the importance and effectiveness of community-based residential treatment and the need to reform or repeal the IMD Exclusion as it relates to inpatient, nonhospital residential SUD treatment.  This yielded questions and answers that included witnesses from SAMHSA and ONDCP stating on the record the importance of reforming the IMD Exclusion.
  • The major legislative result of these hearings was the Comprehensive Addiction and Recovery Act (CARA), which passed the Senate in March 2016, the House in July and was signed into law by President Obama on July 22, 2016. Ultimately, CARA represented a package of bills passed in the House Energy and Commerce Committee, the House Judiciary, the Senate HELP Committee, the Senate Finance Committee, and the Senate Judiciary Committee, that encompass changes in health and criminal justice programs and policies intended to help expand the prevention and treatment of drug abuse and misuse, as well as authorize funding for the related programs. Among the bills included in the measure was H.R. 2646, the Helping Families in Mental Health Crisis Act introduced by Rep. Tim Murphy (R-PA), and S. 1945, the Mental Health Reform Act of 2015 introduced by Sen. Bill Cassidy (R-LA) and Sen. Chris Murphy (D-CT).  TCA monitored all actions on the measures, including hearings, markups, and floor debate.  Although relief from the IMD Exclusion had been considered for inclusion in the package, ultimate the price tag for such changes resulted in it being left out of the package.  TCA updated its members on the congressional activity on addressing the epidemic through regular reports on the legislative process so it could be engaged with policymakers at every step of the way.
  • Parallel to the effort on CARA authorizing legislation, the Obama Administration and Congressional Democrats pressed for $1 billion in new supplemental appropriations to support these programs. TCA joined other organizations in the field in sending letters to Congressional Leadership urging the Congress to fund the initiatives contained in CARA.
  • In December, Congress passed the 21st Century Cures Act, which authorized $1 billion as a special appropriation in response to the opioid epidemic. Subsequently, the Continuing Resolution (CR) passed by Congress that runs through April 28, 2017 included $500 million in appropriations of the $1 billion emergency programs combating the opioid epidemic authorized in the 21st Century Cures Act. Upon enactment of the CR, TCA reported on the notice of funding availability related to this appropriation when it was announced so its members could engage their SSAs accordingly.
  • On another major policy front, TCA organized to educate and mobilize its members to encourage Senate passage of H.R. 5456, the Family First Prevention Services Act, major child welfare reform legislation that would significantly expand funding for family-based treatment by allowing federal IV-E dollars to be used in a time-limited way for evidence-based services, including substance abuse treatment, mental health, and parenting programs.  Despite having passed the House of Representatives unanimously in June, and despite broad bipartisan support in the Senate, objections to aspects of the legislation from a small number of Senators has stalled its forward progress in the Senate.  To help build support and educate members, TCA invited representatives from the Administration on Children, Youth and Families to brief members on a TCA monthly public policy call. Subsequently, TCA drafted and sent a TCA member sign-on letter to Senate Majority Leader Mitch McConnell (R-KY) and Minority Leader Harry Reid (D-NV) urging them to bring the bill up for a vote this fall.  The letters were conveyed directly to the staff responsible for child welfare reform.  TCA continued to mobilize members throughout the fall to secure Senate action on H.R. 5456 before the end of the 114th Congress, with frequent outreach to the Hill and reports to TCA leadership.  While H.R. 5456 was initially included in the 21st Century Cures legislation that advanced in early December, unfortunately, North Carolina Senators and Representatives objected to inclusion of the Family First Prevention Services Act in response to concerns from group homes in that state.  Based on these objections, the Family First Prevention Services Act provisions were removed from the 21st Century Cures Act before passage by the House of Representatives.
  • Once again this year, in February 2016, upon release of the President’s FY17 budget, TCA evaluated all aspects of the proposal related to treatment and the opioid crisis and provided a comprehensive review of the blueprint for the Substance Abuse and Mental Health Administration (SAMHSA) as well as other agencies at the Department of Health and Human Services.  This included information on funding levels for key programs such as the Substance Abuse Prevention and Treatment (SAPT) Block Grant, interventions to prevent prescription drug overdose deaths, and the Department of Justice’s treatment services furnished through the Bureau of Prisons.  Throughout the year, as the House and Senate developed the FY17 appropriations bills, TCA advocated to Members and staff about the importance of increased funding for the Block Grant and its continued importance and relevance as a safety net for people who lack insurance coverage or access to treatment.
  • After the fall elections, TCA has monitored the Trump Transition and updated members in real time on key appointments and announcements. Notably, WSW reported to TCA on the nomination hearings in the Finance and HELP Committees for Rep. Tom Price, President Trump’s choice for the Secretary of Health and Human Services.  WSW also reported to TCA on the confirmation hearing for Senate Homeland Security Secretary-nominee Gen. John Kelly, who discussed the importance of treatment and rehabilitation as part of demand reduction.
  • In advance of the 115th Congress, TCA has also reported out to members on key changes in the House and Senate Leadership for Republicans and Democrats in real-time, including updates on select changes in key Committees of jurisdiction, such as Rep. Michael Burgess (R-TX) becoming the Chairman of the Health Subcommittee at the Energy and Commerce Committee and Sen. Bill Cassidy (R-LA) joining the Senate Finance Committee.  Further, WSW advised TCA on Rep. Jim Sensenbrenner (R-WI) joining the ATR Caucus as co-Chair and Rep. David Joyce (R-OH) joining the ATR Caucus as co-Vice Chair, as well as Rep. Tom MacArthur (R-NJ) becoming the new co-Chair of the Bipartisan Task Force on Heroin.

Building and Strengthening Key Relationships

  • TCA assisted Bob Budsock of Integrity House in his preparation to testify before the U.S. Senate Committee on Homeland Security and Governmental Affairs on Wednesday, April 13, 2016, at a hearing titled “America’s Insatiable Demand for Drugs.” At the invitation of Senator Cory Booker (D-NJ), Bob testified about what was happening through the Integrity House lens, but also spoke about the broad issues relating to demand for drugs; how treatment can decrease the demand for drugs; and barriers to treatment and what Congress can do to ensure that those who need access to treatment receive it. Bob was also able to share TCA’s views on the IMD Exclusion at the hearing and on support for the Durbin Medicaid CARE legislation.  Further, TCA assisted Bob in providing answers to questions for the record related to the hearing.
  • In June 2016, TCA organized and coordinated with Senator Angus King (I-ME) to conduct the Congressional Briefing, “Expanding Access to Treatment: Addressing the IMD Exclusion.” TCA secured the participation of speakers on the panel including Tom Coderre, SAMHSA; Justin Luke Riley, CEO, Young People in Recovery; Joanne Grant, Day One Treatment Program; and Imani Walker, CPS Executive Director, Sacred Authority. The event focused attention on the inequity of the Medicaid IMD Exclusion and energize efforts for a legislative response.
  • Also in June 2016, TCA held its Legislative Day on Capitol Hill as part of its Spring Board Meeting. TCA members conducted approximately 50 meetings with the Members or staff for Congressional offices in the House and Senate.  TCA members sought to boost support for legislation to reform or repeal the IMD Exclusion, build funding for the SAPT Block Grant in FY17, and increase Member participation in the Addiction, Treatment and Recovery Caucus.
  • TCA arranged and planned for the 9/22 meeting in New York City with Robert Asaro-Angelo, Northeast Regional Representative for U.S. Secretary of Labor Tom Perez to allow TCA members to discuss implementation of new overtime regulations and receive technical assistance on compliance and enforcement especially as the measure affects nonprofits like TCA members.
  • For the fall Executive Committee meeting, TCA invited staff for Rep. Hastings and Sen. Durbin to participate in the Fall board meeting and explored further ways of supporting their efforts to reform the IMD Exclusion. TCA also organized a second Day on the Hill opportunity for TCA members with a focus on outreach to Members of Congress and Senators well positioned to work on issues related to treatment – including those outside of TCA member districts – with an emphasis on those serving on the House Energy and Commerce and Ways and Means Committees and the Senate HELP and Finance Committees.  TCA members met with 21 offices on this Day on the Hill.
  • TCA worked to engage Surgeon General Vivek Murthy throughout the year to educate him on the IMD Exclusion and secure support for residential treatment as part of the continuum of care as he developed, “Facing Addiction: The Surgeon General’s Report on Alcohol, Drugs, and Health,” in coordination with SAMHSA. TCA assisted TCA members who hosted the Surgeon General at their program, such as at Odyssey House Louisiana, and facilitated interaction with the Surgeon General at events he attended such as a forum with Senators Menendez and Booker involving Integrity House in New Jersey.  TCA continued to build that high profile in front of the Surgeon General when TCA President Kathy Icenhower participated in the release events for the report in Los Angeles in the fall.
  • TCA attended small-scale events throughout the year hosted by WSW, providing an opportunity for interaction with federal elected officials in a setting outside of Capitol Hill.
  • TCA also continued to advocate for residential treatment in the media when appropriate. In March 2016, TCA responded to an NYT article from February 2016 entitled, “For Mark Willenbring, Substance Abuse Treatment Begins With Research,” whose author Gabrielle Glaser criticized inpatient treatment programs and questioned the research basis for government funded treatment programs. TCA drafted a response to an article in the Daily Beast that ran on May 9, 2016 entitled, “Why Drug Rehab is Outdated, Expensive, and Deadly,” citing evidence-based treatment and the TREAT Act.
  • TCA developed and submitted comments to the President’s Mental Health and Substance Use Disorder Parity Task Force delineating TCA’s concerns about incomplete implementation of parity to date and the urgency of its full implementation and related reform of the IMD Exclusion.
  • TCA supplied its members with a summary of the Surgeon General’s landmark report on addiction.
  • After the fall elections, TCA worked to engage the Trump Transition team and educate them on TCA’s policy priorities as they relate to treatment. TCA prepared materials for submission to the Trump Transition explaining TCA priorities, and TCA worked with members to convey the information to those leading or participating in the transition.

TCA continued to secure a sustainable organization through development activities, increased member communication and improved financial management:

  • TCA held 3 successful board meetings in 2016 that featured timely, expert speakers in the field of substance use disorder treatment, research and prevention.
    • The Winter Board meeting allowed our members to review and revise our strategic plan, set goals and objectives for 2016, review our financial infrastructure, as well as schedule public policy activities (i.e. briefings, hill days) for the year ahead.
    • The spring board meeting featured the 2016-2018 election of TCA officers as well as a discussion with Principal Deputy Administrator, Kana Enomoto and Dr. Kim Johnson, CSAT Director of SAMHSA. The last day of the board meeting featured a TCA briefing on Capitol Hill: Expanding Access to Treatment:  Addressing the IMD and the TCA “Hill Day” where TCA members met with their legislators.
    • Our fall board meeting featured a discussion with the Commissioner of the Administration of Children and Families, Rafael Lopez and Chief Deputy, Jenny Woods about the Family First Prevention Services Act. Robert Madlock of Rep. Alcee Hastings office and Maxx Kanner of Senator Durbin’s office met with TCA members to discuss the IMD legislation and other legislation related to the IMD. Lilliane Drago of the Outreach Program (NY) provided training on Person Centered Treatment. The board meeting ended with TCA members going to Capitol Hill to meet with key legislators about the issues that are important to the filed.
  • TCA began a monthly “Public Policy” conference call which takes place on the 3rd Tuesday of each month at 4:00 pm (EST) and is open to all members and led by Rob Zucker of Winning Strategies Washington, which allowed members to get real time updates on activities and legislation in the field.
  • TCA provided their members with ongoing “Public Policy Updates” that noted activities in Congress, monitored legislation of importance, provided information on federal government activities and updates to include webinars and trainings offered in the field of addiction. TCA also provided a newsletter to its members that documented member program activities and highlight events throughout the country.
  • TCA updated and improved its website in order for it to become more “user friendly” as well as provide information and updates on an ongoing basis to our embers. TCA also maintained and updated its Facebook page.
  • TCA continues to partner with federal agencies such as SAMHSA, ACF, NIDA, ONDCP, DOL, DOJ and HUD, to name a few. TCA participated in many “Stakeholder” meetings and focus groups with our federal partners and the Administration to discuss and promote the continuum of care, funding and research.
  • TCA Executive Director, Pat Clay, participated in a number of Coalitions and working groups to include, The Coalition for Whole Health, Addiction Leadership Group, Re-entry Working Group, Coalition to Stop Opioid Addiction, Mental Health Liaison Group, Facing Addiction and the Justice Roundtable.
  • TCA Executive Director participated in ongoing calls with the U.S. General’s office to discuss their development of the Surgeon General’s report on substance use disorders. TCA Executive Director also participated in conference calls as well as attended in person meetings with the Administration to discuss SUD parity; Executive Director also attended a White House Advocacy Appreciation Day.
  • In July TCA Executive Committee met with Representatives from the GAO to discuss the IMD Exclusion. At this meeting TCA Executive Committee provided answers to questions that were received prior to the meeting as well as supporting documents (i.e. studies, research papers, etc.) on the IMD Exclusion.  Overall, the meeting went very well and TCA was able to provide GAO staff with a lot of useful information.
  • TCA President, Dr. Kathy Icenhower, was appointed to the SAMHSA Women’s Advisory Council (2017-2021). Icenhower’s appointment is due to her very hard work in promoting services for families in the field as well as an example of the great relationship that SAMHSA has with TCA.
  • TCA completed its FY 2015 audit with a clean report which documented TCA’s efforts to improve its systems and practices.
  • TCA continued to offer its members an insurance purchasing program through Sterling and Sterling and Heffernan Insurance which allows TCA to receive royalty income as well as provide our members with a variety of insurance program options.
  • TCA continued to work with HPSI and receive royalty income through this partnership.
  • Alkermes and Heffernan Insurance Brokers continue as Corporate Partners. TCA also continues to partner with ChemRx, who has been a sponsor of a number of TCA events.