Hill Day 2019: Q&A with CEO Ivan Cosimi

SMA Healthcare’s CEO, Ivan Cosimi, participated in Hill Day 2019 in Washington D.C. last week, and sat down for a Q&A to discuss his experience.

Generally speaking, what is (or was) Hill Day?

Hill Day is a day that occurs once a year where professionals from the behavioral health field descend on Washington D.C. and advocate for issues that directly impact the industry. As a member of a national trade association (National Council for Behavioral Health), we bring others who have been impacted by a behavioral health issue.  Individuals from every walk of life join us– could be a patient, family member, a CEO, politician, e.g. anybody impacted by national policy – and get them to advocate for those specific issues.

Why is Hill Day necessary or important?

It all comes down to relationships, and this is an opportunity to work with our legislators, educate them and get them to know SMA a little more.  It also lets them know the details of the laws that they are reviewing and let them know the impact of the law and what it means for our work here in Florida.   For example, if somebody in North Dakota submits a potential law for the entire nation, individuals in Florida may not know what that means for their constituents. That is why it is good for us to go up there and explain why that law would be important.

What is the biggest challenge you face while there?

Anybody who is plugged into the national political environment knows that it is so divided – that is probably the biggest obstacle right now. Consider the discussion around gun violence recently.  Politicians have tried to conflate that issue with mental health, which only increases the stigma of mental illness.  This is a challenge for us, just knowing that mentally ill are more likely to be a victim of violence than a perpetrator. In general, the political environment is an obstacle for us.  

However, on the flip side, mental health and substance use seems to be the one issue that people can agree to on a bi-partisan basis, so most of our legislators see it as an issue and know something needs to be done.

What were you able to accomplish while in D.C.?

What we accomplished was getting each representative to hear a consistent message on the five things we were trying to get done while in D.C. I was part of the Florida delegation that went – there were about 20 of us. We visited all 27 House of Representatives staff and our two Senators. Each contingent was responsible for visiting representatives that covered their area. That’s important because, as I mentioned, having those relationships is crucial. When a representative comes back to Palatka, for example, they will remember I was there pushing those national-level policies and can connect the dots and know that SMA can be a resource for them when it comes to tackling these issues.

What can we hope to see in the coming months? 

What are we hoping to have happen? Well, we brought five major issues to Hill Day and are hoping for some or all of them to pass. All of these items have impact to the federal budget, and we are trying to educate them about those impacts and what we are experiencing.

• We asked for the removal of regulatory hurdles as it relates to medication assisted treatment. Right now, we when we have an ANRP that wants to provide treatment for opioid addiction, they are limited in the first year to 28 clients. In year two, they are allowed 100 clients, and in year three allowed 240 clients. We have asked for the release of that cap so we can provide treatment to those who need it.

• We asked for the removal of restrictions on Medicare reimbursement for marriage and family therapists and mental health counseling. Right now, they are not allowed to bill for Medicare services – only Licensed Clinical Social Workers (LCSW’s) are allowed to do so. That is a workforce issue for us, as trying to find LCSW’s is very hard – it is a very competitive credential. The requirements in Florida are the same for Licensed Mental Health Counselors (LMHC’s) or LCSW; however, one can bill Medicare and the other can’t.

• We also asked for the re-instating of Medicaid eligibility for those who are incarcerated. When someone goes into jail, they lose all their Medicaid benefits. As they re-enter society, it takes time for them to get back on Medicaid and to receive services. What we would like to see is them receive eligibility 30 days prior to release. That allows us to come into the jail, provide services and make sure that when they return to the community, there is no interruption in services.

• The state of Florida gets $300 million in substance use funding for the entire state – $200 million comes from the federal government, meaning the state of Florida only has $100 million invested. So, what we have asked from our federal representatives is to not let that funding lapse or drop off. A lot of these items have three-year terms and we have asked them to re-up those terms. Florida, unlike other states, is heavy reliant on the federal dollar.

• The last thing we did was talked about CCBHC’s – Certified Community Behavioral Health Centers. They are actually in nine states right now. They allow those who qualify – SMA would qualify – to provide all of the necessary services, from physical to behavioral health, and provides a reimbursement level at exact cost — it allows for reimbursement that can compensate you for your costs and keep you “whole.” We asked them to continue that and fund all 50 states – these things have proven to work, and we want them to go ahead and get that done.

Do you have any additional thoughts about your experience?

I love being able to advocate for the services we provide at SMA.  I believe that when delivered in the manner that SMA is accustomed to, we can make our communities better.  More importantly, by participating in Hill Day, I believe that I can advocate for those who don’t have the opportunity to do so.  Hill Day gives me unique perspective. This was the biggest Hill Day in National Council history, so there were a lot of folks there and I felt like we had power in numbers. It was a good experience, and I look forward to seeing if our efforts will help to move our industry forward to serve more.