Bazelon Center Mental Health Policy Reporter

Volume VI, No. 2, May 8, 2007

Snapshot of Policy Issues

In this issue:

• State Children’s Health Insurance Program(SCHIP) Reauthorization
• No Child Left Behind
• Criminal Justice and Mental Health
• Medicaid and Schools
• Genetic Information
• Medicare Mental Health
  

Newsbytes:

• North Dakota and FOA
• May is Mental Health Month
  

SCHIP Reauthorization

Congressional efforts are underway to renew the State Children’s Health Insurance Program (SCHIP). SCHIP, enacted in 1997, provides health insurance coverage to uninsured low-income children (under 19). As part of the partnership between federal and state governments, states may expand coverage to eligible children through the Medicaid program, establish a separate children’s health insurance program or use a combination of these approaches.

States electing to expand their Medicaid program to cover these children offer comprehensive mental health services. However, states that opt to establish a separate health insurance program (a benchmark plan modeled after private health insurance) have imposed limits on mental health services that would not be permissible in Medicaid. These limits include caps on inpatient and outpatient care.

The SCHIP statute also allows states that opt to create separate programs to reduce the actuarial value of mental health benefits by 25% —that is, the mental health benefit in these separate SCHIP plans need only be equivalent to 75% of the benefit in the benchmark plan itself. This allows these states to provide significantly less mental health coverage.

The Bazelon Center and its partner organizations are working to ensure that all SCHIP plans provide mental health coverage equivalent to the coverage provided for general health care. On February 28, more than 40 national organizations representing children in the child welfare and mental health system sent a letter urging key leaders to use the opportunity afforded by the reauthorization process to prohibit disparate limits on mental health care in separate SCHIP plans.

On March 27, Bazelon Center policy director Chris Koyanagi testified before the House Energy and Commerce Subcommittee on Health at a hearing, “Insuring Bright Futures: Improving Access to Dental Care and Providing a Healthy Start for Children." Chris was invited to speak specifically about child mental health services and access to care in the private and public systems. Notably, her testimony discussed the inequitable coverage of mental health services under SCHIP and pressed the committee to remedy discriminatory limits on mental health services in the separate state plans, including the further limitations allowed for under actuarial equivalent plans. Several legislative efforts are in the works to address the problem.

• The Children’s Health First Act (H.R. 1535, S. 895), introduced by House Energy and Commerce Committee Chairman John Dingell (D-MI) and Senator Hillary Rodham Clinton (D-NY), would eliminate the provision in SCHIP that allows for reduction of mental health benefits.

• Similarly, the Children’s Health Insurance Program Reauthorization Act of 2007(S. 1224), introduced by Senators Edward Kennedy (D-MA), John Rockefeller (D-WV) and Olympia Snowe (R-ME), would eliminate this provision while also mandating that mental health benefits be included in separate health insurance plans. However, neither bill provides for parity of mental health benefits in the separate health insurance plans.

• Senators John Kerry (D-MA), Gordon Smith (R-OR), Pete Domenici (R-MN) and Edward Kennedy (D-MA) have teamed up to prohibit separate SCHIP health insurance plans from providing inequitable coverage of mental health services as compared to general health services. This legislation, entitled the Children’s Mental Health Parity Act, is expected to be introduced this week.

No Child Left Behind

Congress has begun examining issues relating to reauthorization of the No Child Left Behind Act (NCLB). Bazelon and its coalition partners are promoting school-wide positive behavior supports (PBS) in the context of NCLB as a way of helping to improve academic outcomes and overall school climate. On April 30, a group of national organizations, spearheaded by Bazelon, sent a letter to the chair and ranking members of the House and Senate committees with jurisdiction over NCLB.

Based on years of behavioral and biomedical research, PBS lays out a new direction for child mental health systems, linking to a new movement in education. By reinforcing desired behaviors and eliminating inadvertent reinforcements, PBS changes student performance, leading to benefits that are appreciated by students, staff and school personnel. Schools that implement PBS are able to identify the students who need early intervention or intensive mental health services and either provide or facilitate the provision of services to meet those children’s needs.

Around the country, PBS initiatives have demonstrated successful outcomes, including reduced disciplinary problems, improved test scores and an increased climate of collaboration within the school. Currently, PBS and early intervention services are encouraged for individual students through the Individuals with Disabilities Education Act (IDEA). However, school-wide implementation is more effective, both for students with special education plans and other youngsters. (See Way to Go: School Success for Children with Mental Health Care Needs, the Bazelon Center’s report on schools’ use of school-wide PBS linked to mental health services.)

What you can do:

Contact Members of the House and Senate committees to urge inclusion of school-wide Positive Behavior Support in programs of the No Child Left Behind Act. Contact your Senator or Representative on the relevant committees, listed below, and tell them:

• Funds under the NCLB should be available to states and schools to implement programs that improve the school climate for learning, such as school-wide positive behavior support and other early intervention services.

• Mental health and education groups have forwarded specific legislative language to accomplish this; please support these changes.

Criminal Justice and Mental Health Collaborations

Enacted in 2004, the Mentally Ill Offender Treatment and Crime Reduction Act (P.L. 108-414) provides grants to states and localities to develop programs for offenders with mental illnesses. Grantees can use the funds for several purposes, including jail diversion, improved services for inmates, law enforcement training, mental health courts and other court-based and re-entry services. Administered by the Department of Justice, the program received $5 million in fiscal years 2006 and 2007.

The program received 250 grant applications in 2006, but due to the limited funding only 27 communities (11%) received grants. Recently, several members of the House and Senate called for increased funding for fiscal year 2008.

Medicaid and Schools

Senator Edward Kennedy (D-MA) and Representatives John Dingell (D-MI), George Miller (D-CA) and Ed Whitfield (R-KY) have re-introduced the Protecting Children's Health in Schools Act (S. 578, HR 1017). This legislation would define how schools might use Medicaid for health and mental health services. It would enable schools to bill Medicaid for appropriate covered services for children with disabilities. It would also resolve longstanding issues in Center for Mental Health Services (CMS) guidelines on school billing.

The legislation was introduced to address a proposal in the President’s fiscal year 2008 budget plan to cut Medicaid reimbursement for school-based transportation services and other administrative support related to services provided in school settings. The bill has been referred to the House Education and Labor Committee and the Senate Health, Education, Labor and Pensions Committee.

Genetic Legislation Passes House

Legislation to help millions of American who currently forego genetic testing for fear of discrimination in insurance coverage and employment passed the House on April 25. The Genetic Information Non-Discrimination Act (H.R. 493) was introduced by Louise Slaughter (D-NY. H.R. 493 would bar insurers from denying coverage or increasing financial costs based on data obtained from genetic tests. It would also prohibit employers from making employment decisions (such as promotions, firing or hiring) based on such information. The Senate companion (S. 358), sponsored by Olympia Snowe (R-ME), was approved by the Senate Health, Education, Labor and Pensions Committee on January 31. The Senate is likely to vote on the bill in the near future.

Medicare Mental Health Legislation

The chairman of the House Ways and Means Subcommittee on Health, Rep. Pete Stark (D-CA), has re-introduced H.R. 1663, the Medicare Mental Health Modernization Act of 2007, to update Medicare’s mental health benefits. The legislation would provide coverage of community-based services, including psychiatric rehabilitation and intensive case management. Additionally, the bill would eliminate the discriminatory outpatient co-payment of 50% for mental health services, compared to 20% for other outpatient services. The legislation is endorsed by the Mental Health Liaison Group, of which Bazelon is an active member.

Newsbytes:

North Dakota and the Family Opportunity Act

North Dakota became the first state to elect the Family Opportunity Act option, enacted under the Deficit Reduction Act. This bill provides access for families to health and mental health care needed by children with severe disabilities under a Medicaid buy-in program. The Family Opportunity Act permits states to allow families with incomes up to 300% of the federal poverty level and children up to age 18 who have a severe disability, including mental illness, to buy into Medicaid for their child on a sliding-scale basis. The legislation will help many families who are unable to access needed health care for their child without relinquishing custody to the child welfare system in order to obtain intensive Medicaid services.

May Is Mental Health Month

May is national mental health awareness month and several events on mental heath issues were held by members of Congress. Representatives Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) instituted Mental Health Parity Day where they rallied for support of the "The Paul Wellstone Mental Health and Addiction Equity Act"(H.R.1424). The co-chairs of the House Mental Health Caucus, Representatives Grace Napolitano (D-CA) and Tim Murphy (R-PA) introduced a House resolution highlighting important mental health findings (H.Con Res 130).

In the Senate, the Mental Health Caucus, chaired by Senators Edward Kennedy (D-MA), Pete Domenici (R-MN), Tom Harkin (D-IA) and Gordon Smith (R-OR), held staff briefings on the care and coverage available to members of the National Guard and Reserves who have served in Operation Enduring Freedom and Operation Iraqi Freedom. The Senate HELP Committee is set to hold its first hearing on SAMHSA reauthorization the week of May 7. The Caucus is also planning another event in May on anti-stigma.

Bazelon worked with key children’s mental health groups on a Senate briefing scheduled for May 8 to examine successful approaches to school success for children with mental health disorders. The briefing is co-sponsored by Senators Gordon Smith (R-OR), Pete Domenici (R-NM), Tom Harkin (D-IA), Christopher Dodd (D-CT) and Susan Collins (R-ME).