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 VIII, No. 7, October 15, 2009

We’re on the Road to Health Care Reform

House and Senate Ready to Merge Their Committee Bills

In this Issue

• Senate Finance Committee Approves Health Care Reform Bill
• Time Winding Down for Federal Appropriations (updated 11/3/09)
• House Approves Medicare Premium Fairness Act

Newsbytes

• Education Secretary Proclaims Now is the Time for NCLB Rewrite
• Pamela Hyde Nominated to Head SAMHSA
• Genetic Nondiscrimination Act Rules Released
• Rules Proposed for ADA Amendments Act
• Rules to Implement Parity Law Delayed
• Report Documents all Federal Spending on Children
• National Council on Disability Releases Health Care Report

On the national news front, it often seems as if it’s health care reform all the time, and now that all five congressional committees have approved bills, as described in this Reporter, the focus may become ever more intense. But there’s more happening in the policy arena that’s of interest to people with mental disabilities. Time is running down on Senate approval of the fiscal year 2010 federal budget for operations by the key departments of Justice, Health and Human Services, and Education, for some of which the House has granted increases.  And the prospect of increased Medicare premiums led the House to approve a bill that will “hold harmless” 11 million seniors and people with disabilities.

Newsbytes highlight a schedule for stakeholder meetings on Education Secretary Arne Duncan’s desire for “a transformative education law,” and two proposed rules —to protect individuals from discrimination based on personal genetic information and to implement the 2008 amendments to the Americans with Disabilities Act.

Senate Finance Committee Approves Health Care Reform Bill

On October 13, the Senate Finance Committee became the last of the five congressional committees to approve health care reform legislation. The vote was 14-9, with one Republican supporter, Senator Olympia Snowe (R-ME) —the only member of her party to approve any of the committees’ bills.

The Senate leadership now begins in earnest the process of merging the Finance Committee bill with S. 1679, the Affordable Health Choices Act, approved by the Senate HELP Committee prior to the August recess. This task is expected to continue through most of October as leaders await an estimate from the Congressional Budget Office on the cost of a combined bill.

The issue of whether to include a public insurance plan option, central in the news for some time, will be at the forefront of the discussion during the merger process and Senate floor debate. S. 1679 provides for such an option in the insurance exchange, while efforts by Senators Jay Rockefeller (D-WV) and Charles Schumer (D-NY) to amend the Finance Committee bill failed. The Senate will likely engage in a two- to three-week floor debate prior to voting on a final bill.  

Many improvements were made to the Senate Finance Committee bill during the markup process, including:

• An amendment by Senators Debbie Stabenow (D-MI), John Kerry (D-MA) and Ron Wyden (D-OR) that would apply the Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act (parity law) to all benefit plans offered in the exchange. 
• An amendment by Senator Stabenow that would clarify Medicaid coverage of therapeutic foster care services.
• Amendments by Senators Stabenow and Jeff Bingaman (D-NM) that would expand the list of eligible providers in the Medicaid option promoting integrated health care and medical homes to include community mental health centers and would clarify that individuals with serious and persistent mental health conditions would be able to receive services.
• An amendment by Senator Schumer to establish the Community First Choice Option, which would create a Medicaid state plan option to provide home- and community-based attendant supports and services to individuals with disabilities who would otherwise be served in an institution.
• An amendment by Senator Rockefeller that requires states to continue the Children’s Health Insurance Program (CHIP) through 2019 and maintain existing Medicaid coverage for children. And an amendment by Senator Bingaman that establishes a coordinated and unified enrollment/renewal system for Medicaid, CHIP and the subsidy program available through the health insurance exchanges to help keep individuals from falling through the cracks.

Across the Capitol, the House leadership is working to combine the three committee-approved bills (H.R. 3200, America’s Affordable Health Choices Act), with the first week in November projected for a floor vote. Chairmen of the three House Committees, Henry Waxman (D-CA), Charles Rangel (D-NY) and George Miller (D-CA), released a press statement calling approval of the health care bill by the Senate Finance and “historic day in our decades-long fight to bring quality, affordable health care for every American.” See http://edlabor.house.gov/newsroom/2009/10/waxman-rangel-miller-statement.shtml

Lobbyists have been hard at work on all fronts, and state governors have also jumped in. After 22 governors sent a letter to congressional leaders in support of health insurance reform, one of their recent colleagues, from Kansas, Health and Human Services Secretary Kathleen Sebelius, commented: “These Governors know that without reform, health care costs will continue to rise and they will continue to struggle to balance their budgets. Reform will help give our states the relief they need and give the American people the security and stability they deserve."

The Bazelon Center has produced summaries of the House and Senate bills’ potential impact for mental health consumers.  Please visit http://www.bazelon.org/issues/healthreform/index.htm for these summaries and links to the bills themselves, with ongoing updates. Also see a September 24 letter by the Mental Health Liaison Group to Finance Committee Chairman Baucus, expressing support for and recommending improvements to the America’s Health Future Act.

Time Winding Down for Federal Appropriations

The 111th Congress, like previous Congresses, has had a hard time finalizing its mandatory spending bills before the start of the fiscal year, which began October 1st.  Although the House has passed all spending bills, the Senate still lags in floor votes. Congress passed a continuing resolution (P.L. 111-68) on the Legislative Branch Appropriations bill to keep the government operating. That will expire October 31.

Update:
As of November 2, Congress has approved a second continuing resolution providing temporary appropriations to the federal agencies whose FY 2010 appropriations bill have not passed (FY 2010 began Oct 1). The resolution runs through December 18 and was included in the Interior Department Appropriations Act for FY 2010 (HR 2996), signed by the President October 30 (P.L. 111-88).

The Departments of Justice, Health and Human Services and Education are among the few remaining departments awaiting Senate approval. As a result, funding has yet to be finalized for grant programs such as the Mentally Ill Offender Treatment and Crime Reduction Act, Second Chance Act, the mental health and addiction portfolio administered by SAMHSA and a range of education programs of importance to individuals with disabilities.  

Noteworthy funding levels include:

• $10 million approved by the House and $12 million approved by the Senate committee for the Mentally Ill Offender and Treatment and Crime Reduction Reauthorization and Improvement Act (P.L. 110-416).
• $100 million approved by the House the Second Chance Act  (P.L. 110-199) programs and $50 million approved by the Senate Committee.
• The President’s FY 2010 budget included a new National Activities grant assistance program within the office of Safe and Drug Free Schools, at a request of $100 million to support improving school culture and climate. The House approved $50 million and the Senate Committee approved $81 million. The competitive grants, designed to help schools foster safe, secure and drug-free learning, will help (1) reduce the number of suspensions and expulsions related to disruptive behavior and nonviolent offenses and reduce the time teachers have to spend disciplining students for engaging in disruptive behavior and other minor nonviolent offenses, and (2) reduce the amount of serious violent crime in schools (including on school grounds, as well while students are on the way to and from school) and among school-age youth in the community.
• $125.3 million approved by the House for the children’s mental health services program (an increase of $16.9 million over FY 09) and $120.3 million by the Senate committee. The mental health block grant is frozen at $420.7 million in the House and in the Senate. Similarly, the jail diversion program is frozen-funded at $6.68 million in the House and the Senate.
• $68 million approved by the House for the PATH program for homeless mentally ill individuals (an increase of $8.3 million over FY 09) and $65 million by the Senate committee.
• $14 million approved by the House for the primary care and behavioral health integration program for individuals with serious mental illnesses (an increase of $7 million over FY 09) and $9 million by the Senate committee.

House Approves Medicare Premium Fairness Act

Representatives Dina Titus (D-NV), Charles B. Rangel (D-NY) Pete Stark (D-CA), Henry Waxman (D-CA), John D. Dingell (D-MI), Frank Pallone (D-NJ) are sponsors of H.R. 3631, the Medicare Premium Fairness Act. They have successfully advanced legislation (in a 406-18 floor vote on September 24) that will help protect 11 million seniors, including those with a disability, from unfair increases in their 2010 Medicare Part B premiums. The Bazelon Center has endorsed the bill, along with several other disability and senior groups, including AARP, the National Committee to Preserve Social Security and Medicare and the Consortium for Citizens with Disabilities..

Currently, an estimated 42 million seniors and individuals with disabilities are enrolled in Medicare Part B. The legislation would extend a current “hold harmless” policy to all beneficiaries to avoid a reduction in their Social Security checks if the Part B premium increase is projected to be greater than the increase in Social Security. The Senate is attempting to pass the bill by unanimous consent.

Newsbytes

Education Secretary Proclaims Says Now is the Time to Begin NCLB Rewrite
In a speech to more than 200 leaders of major education groups, U.S. Secretary of Education Arne Duncan asked that they help to “build a transformative education law” that guarantees all children “the education they want and need—a law that recognizes and reinforces the proper role of the federal government to support and drive reform at the state and local level." The Elementary and Secondary Education Act of 1965 (ESEA) was last reauthorized by Congress in 2002 and is now known as the No Child Left Behind Act. With health care reform a congressional priority at this time, it is unclear when education reform will take center stage. 

The Department of Education has begun holding a series of education sessions for stakeholders to offer input about the law. Upcoming meetings will be at the Barnard Auditorium at the department's headquarters in the Lyndon Baines Johnson Building, 400 Maryland Ave. S.W., Washington, D.C. (see map), on the following dates:

• Wednesday, Oct. 21 from 2 p.m. to 3:30 p.m.
• Wednesday, Nov. 4 from 2 p.m. to 3:30 p.m.
• Friday, Nov. 20 from 1 p.m. to 2:30 p.m.
• Wednesday, Dec. 2 from 2 p.m. to 3:30 p.m.

Carmel Martin, assistant secretary for planning, evaluation, and program development, and Thelma Melendez de Santa Ana, assistant secretary for elementary and secondary education will host the events.   
The Bazelon Center and the coalition for School Success for All has been promoting H.R. 2497, The Positive Behavior for Safe and Effective Schools Act (introduced by Representative Phil Hare, D-IL) as a legislative response to help schools achieve a climate that is conducive to learning through the use of school-wide positive behavior supports. See our May 27th Mental Health Policy Reporter.  

Pamela Hyde Nominated to Head SAMHSA
The Bazelon Center applauds the President’s nomination of Pamela Hyde as Administrator of The Substance Abuse and Mental Health Services Administration (SAMHSA), the agency responsible for mental health and addiction treatment and prevention services. See the White House press release and remarks by HHS Secretary Kathleen Sebelius.

The programs and services administered by SAMHSA were last reauthorized in 2000, in the Children’s Health Act (P.L.106-310). The Bazelon Center is confident that Pam Hyde’s leadership will help propel the agency forward even as the Administration and Congress advance national health care reform.

Genetic Nondiscrimination Act Rules Released
On October 7, the U.S. Departments of Health and Human Services (HHS), Labor and the Treasury (Internal Revenue Service) released an interim final rule with request for comments and notice of proposed rulemaking (NPRM) on Title 1 of the Genetic Information Nondiscrimination Act of 2008 (GINA, P.L 110-233). See the Bazelon Center’s summary for details of the law that was enacted to protect individuals from insurance and workplace discrimination related to their personal genetic information. 

The NPRM is issued by HHS’ Office for Civil Rights and extends 60 days for comments to proposed changes to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule to prohibit health plans from using or disclosing genetic information for underwriting purposes. The rules and information on filing comments can be accessed at http://edocket.access.gpo.gov/2009/pdf/E9-22504.pdf

Rules Proposed for Americans with Disabilities Act Amendments Act
The U.S. Equal Employment Opportunity Commission has released a notice of proposed rulemaking (with a 60-day public comment period ending November 23) on revisions to regulations implementing the Americans with Disabilities Act of 1990 (ADA), as amended by the ADA Amendments Act of 2008.The regulations focus on the definition of disability in Title I (employment discrimination). The ADA Amendments became effective on January 1, 2009. To access the announcement, including information on how to submit comments, visit http://www.eeoc.gov/ada/amendments_notice.html. The Bazelon Center’s comments, which you are free to use as a model, are at www.bazelon.org/issues/disabilityrights/ADAAA_regs_comments11-23-09.doc (Word document). .

Rules to Implement Parity Law Delayed until 2010
Regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (P.L. 110-343) have been delayed until 2010 (see letter from HHS Secretary Kathleen Sebelius).  Before the law’s effective date (October 3), House and Senate lawmakers sent letters to the Secretaries of the three departments (Labor, HHS, and Treasury) responsible for the law’s guidance, urging timely promulgation to avoid misinterpretation and to conform to congressional intent. Advocates and lawmakers who pressed for timely release continue to assert that proper guidance is needed as soon as possible  to ensurethat parity goals are achieved in health insurance coverage.

Report Documents All Federal Spending on Children
First Focus, a nonprofit advocacy group representing children’s, has released the latest edition of its comprehensive guide to all federal spending on children. Children’s Budget 2009  is available at http://www.firstfocus.net/Download/CB2009.pdf. One of many key findings in the book is that children’s spending makes up less than 10 percent of the entire non-defense budget. 
Representative Danny Davis (D-IL) has re-introduced legislation (H.R. 3772, Children’s Budget Act) that would provide a detailed analysis of all federal spending on children. 

National Council on Disability Releases Health Care Report
The National Council on Disability (www.ncd.gov) has released a report to focus attention on the nation’s health care disparities among people with disabilities. The report, The Current State of Health Care for People with Disabilities, provides recommendations to ensure that health reform responds to the basic needs of people with disabilities by making coverage available and affordable to without limitations based on pre-existing conditions.