Bazelon Center Mental
Health Policy Reporter
Welcome
to the Bazelon Center Mental
Health Policy Reporter. Available exclusively online and to
our email subscribers, the Reporter supplements the Bazelon Center's
Action Alerts by providing a periodic bulletin on significant
policy developments that affect people with mental illnesses.
Volume VII, No. 1, January
2, 2008
Congress Weighed Down by White House Opposition
In this issue:
In the waning days before adjournment, the first session of the
110th Congress passed legislation with funding for mental health
and children’s health services diminished by the threat of
Presidential veto. However, the bill mandating insurance coverage
for mental health services on a par with medical coverage was held
over yet again. Grants to foster collaboration between mental health
and criminal justice did receive an increase for fiscal year 2008,
though not the hoped-for doubled funding. And at the eleventh hour,
a bill passed to create (fiscal) incentives for states to submit
records of certain people with mental illnesses to the FBI’s
background-check system for gun purchases.
Mental Health Funding
Three months after the start of the 2008 fiscal year, Congress
had yet to complete its work on 11 of the 12 mandatory appropriations
bills. A series of continuing resolutions was passed to keep the
government operating at fiscal 2007 levels and defense spending
was the only bill signed by the President. And, although many of
the outstanding bills had been approved by both houses of Congress,
veto threats loomed over the majority for spending that exceeded
the President’s request.
The President’s veto threat was realized when Congress sent
over the appropriations bill (H.R. 3043) that funds the Departments
of Labor, Health and Human Services and Education, passed by a
majority that was insufficient to override a veto. This bill finances
mental health programs and services administered by the Center
for Mental Health Services (CMHS) at the Substance Abuse and Mental
Health Services Administration (SAMHSA). As the year’ wound
down, legislators, faced with a President unwilling to compromise
on discretionary spending, crafted an omnibus appropriations bill
(H.R. 2764) that came close enough to meeting the President’s
spending ceiling of $933 billion for all discretionary spending
(minus Defense). As a result, Congress was able to adjourn the
first session of the 110th Congress with its appropriations work
completed, avoiding a year-long continuing resolution or a government
shutdown.
Mental heath programs were funded at levels near those of fiscal
2007, although community-based mental health services absorbed
some cuts. Funding was cut for two notable programs, the mental
health block grant, which provides community-based mental health
services to children and adults with severe mental disabilities,
and the systems of care program for children with serious emotional
disturbance were cut ($7 million and $2 million, respectively).
But the suicide prevention program received a $3.2 million increase
over last year’s levels.
Despite pressure from the Administration, Congress restored many
of the dollars for programs funded from the CMHS discretionary
budget (including jail diversion, seniors mental health, anti-violence
and consumer technical assistance) that had faced cuts and/or elimination
under the President’s budget request. See chart for details.
Medicare, Medicaid and SCHIP
Congressional efforts to provide health care coverage to 10 million
children through the State Children’s Health Insurance Program
(S-CHIP) were irrationally sidelined by the White House this year.
The President twice vetoed legislation (H.R. 976 and H.R. 3963)
that would have strengthened the program over five years, providing
enough money to extend coverage to approximately 4 million more
children than were covered over the past 10 years.
SCHIP was set to expire on September 30 but had been maintained
under a continuing resolution, giving Congress additional days
to try to meet the Administration’s objections to the bill.
After failing to override the first veto, Congress ended the year
with an extension of the program that keeps it operating until
March 31, 2009. This extension was included in S. 2499 (Medicare,
Medicaid and SCHIP Extension Act).
Unfortunately, the extension bill maintains coverage for children
currently enrolled in SCHIP but does not extend new coverage that
would have helped to reduce the number of uninsured eligible children.
Nor does it include parity protections for children in need of
mental health care. Both of the SCHIP bills vetoed by the President
included mental parity for SCHIP children and eliminated the discriminatory
provision in the law allowing states electing to develop benchmark
equivalent plans to lower the amount of mental health coverage
to 75 percent of the coverage provided in the benchmark plans.
(See the Bazelon Center’s May
8,
2007 Mental Health Policy Reporter.)
Successfully, S. 2499 does block the Administration from acting
on proposed changes to Medicaid’s rehabilitation services
option and school-based administration or transportation costs
and from taking other steps to restrict reimbursement for such
services. The bill extends this moratorium for six months (until
June 30, 2008). These proposed changes, outlined in the President’s
fiscal year 2008 budget proposal and subsequently released by the
Centers for Medicaid and Medicare Services, would effectively deny
needed Medicaid funding for community-based mental health services
for children and adults
and also drastically affect Medicaid reimbursement for school-based
services, including outreach and enrollment.
On the Medicare front, the Senate failed to produce a package
of improvements that was passed by the House in the CHAMP Act (Children’s
Health and Medicare Protection Act). CHAMP provided for significant
reforms of the Medicare program, including extending mental health
parity to its outpatient benefit. Unfortunately, S. 2499 did not
contain the mental health parity protections. Only scaled-down
improvements were included, such as the block of a scheduled 10-percent
cut in the Medicare payment rate for physicians. This postponement
ensures that seniors and people with disabilities can continue
to receive care through doctors they choose.
As of this writing, the President is expected to sign S. 2499.
Congress will likely continue work in these areas on more comprehensive
legislation in its next session, beginning in mid-January 2008.
Mental Health Parity
Negotiations to produce a mental health parity bill acceptable
to both Senate and House ended with adjournment and will likely
resume in the next session. One of the main areas to be agreed
upon rests with the minimum benefit standard (Diagnostic and Statistical
Manual or no definition or reference). It has been a long journey
on the path to achieving parity of insurance coverage for mental
health with medical and advocates should be commended for advancing
both S. 558 (Mental Health Parity Act) and H.R. 1424 (Paul Wellstone
Mental Health and Equity Addiction Act of 2007). The Senate passed
S. 558 and for the first time, H.R. 1424 was approved by each of
the three committees of jurisdiction. (See the Bazelon Center's
November
7, 2007 Mental Health Policy Reporter.)
The House adjourned before extending the 1996 Parity Act for another
year, as had been done in previous years. However, it will likely
be extended again in January. We believe this brief delay (for
lifetime and annual limit parity) will not result in any diminished
enforcement of the Act.
Mental Health and Criminal Justice Collaborations
House and Senate legislation to reauthorize and improve the criminal
justice and mental health collaboration grant program, administered
by the Department of Justice (P.L. 108-413, Mentally Ill Offender
Treatment and Crime Reduction Act), will carry over into next year
as Congress adjourned for the session. The House Judiciary Committee
approved H.R. 3992, introduced by Representatives Bobby Scott (D-VA)
and Randy Forbes (R-VA) and the bill heads next to the House floor.
The Senate bill (S. 2304), introduced by Senators Edward Kennedy
(D-MA) and Pete Domenici (R-NM) awaits consideration by the Judiciary
Committee. (See the November
7 Policy Reporter.)
The bipartisan bills would renew the core MIOTCRA grant program
and increase the authorization from $50 million to $75 million.
It would also renew the mental health courts grant. The bills also
provide for new grants in need-based areas, including greater law
enforcement training; effective treatment of female mentally ill
prisoners; statewide planning outreach to coordinate the treatment
of incarcerated individuals with mental illnesses and provide for
new interventions; improved screening, identification and assessment
of mentally ill inmates; and increased coordination of transitional,
post-release services.
Despite early indications of a doubled funding from the $5 million
appropriated in each of the previous two years, MIOCTRA was increased
only to $6.5 million for fiscal year 2008.
Gun-Purchase Background Check
The National Instant Criminal Background Check System
(NICS) is a computerized system managed by the FBI that searches
criminal
records and other information to determine whether an individual
is eligible under federal or state law to purchase a gun. Just
before adjourning, Congress passed H.R. 2640, The NICS Improvement
Amendments Act of 2007, that would create incentives (by authorizing
substantial new funds over five years) for states to submit the
records of certain people with mental illnesses and criminal backgrounds
to the FBI. Under current law, gun dealers must check a purchaser’s
background before selling a gun. The President is expected to sign
the bill.
The NICS Improvement Amendments Act, sponsored by Senator Charles
Schumer (D-NY) and Representative Carolyn McCarthy (D-NY) was based
on legislation that has floated around Congress for five years.
Mental health advocates have repeatedly expressed concern about
the use of broad, stigmatizing definitions of people with mental
illnesses whose information would be subject to the NICS. They
fear that this approach would promote the idea that violence and
mental illness are inevitably linked--a notion disproved by studies
showing that people with mental illnesses are no more violent than
others.
Privacy concerns have also been raised in recognition that the
process could discourage mental health consumers in need of care
from seeking help. The list of individuals banned from buying a
gun would include people “adjudicated as a mental defective
or those committed to a mental institution.” The mental health
records of law-abiding citizens who have needed involuntary mental
health treatment at some point in their lives would be among those
collected.
The legislation was modified to reflect some of the concerns
raised by mental health advocates. H.R. 2640 includes better
language
to define which mental health records must be reported by the
federal agencies and departments to the NICS. It would also
allow people
to petition for restoration of gun ownership rights. However,
others issues that remain outstanding, and implementation of
the law,
if enacted, would need to be monitored very carefully
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