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. 3, April 9, 2009

Congress Springs Forward on Budget and Bills

In this issue:

• Budget Resolutions Help Set the Stage for Healthcare Reform
• CLASS Act Introduced for Long-Term Care Support in the Community
• Bill Would Strengthen Protections for Juveniles
• Medicare Waiting Period Would End for SSDI Recipients
• Legislation Would Create a Criminal Justice Commission

Newsbytes

• Early Childhood Experience Matter, Reports Zero to Three
• JJDPA Annual Report
• Community Corrections and People with Mental Illnesses
• NCD Annual Report to the President and Congress

Before going home for their spring break, both houses of Congress took the first big step toward a 2010 budget that reflects the President’s priorities, including reform of the nation’s healthcare system. Members also introduced a flurry of bills that, should they become law, would significantly improve protections for juveniles and increase access to the services and supports that people with serious disabilities need for an independent life in the community.

Both Houses Approve Budget Resolutions

On April 2, both houses of Congress handily approved separate versions of a fiscal 2010 budget resolution. The resolutions set a framework for tax and spending legislation. Both provide most cost estimates of what the President had sought and help set the stage for advancing healthcare reform (see the release by Senate Finance Committee Chairman  Max Baucus).

Notably, the House bill (H. Con. Res. 85, passed 233-196) includes language that would allow healthcare reform legislation to advance through the filibuster-proof reconciliation process. The Senate’s (S. Con. Res. 13, passed 55-43) does not.

The President’s budget blueprint, released on February 26, includes $634 billion over 10 years to expand health care. The House and Senate resolutions provide a deficit-neutral budget reserve fund to help pay for healthcare reform.
The language in the resolutions essentially provides guidance to the committees of jurisdiction. The resolutions do not direct what the policies would look like or how much they would cost.

Both resolutions failed to garner the support of a single Republican. Conference discussions will begin when Congress reconvenes in the week of April 20.

CLASS Act Introduced in House and Senate

On March 25, Senator Edward Kennedy (D-MA) and Representatives Frank Pallone (D-NJ) and John Dingell (D-MI) re-introduced the Community Living Assistance Services and Supports (CLASS) Act (S. 697 and HR 1721). The legislation would create a new national insurance program for adults looking to obtain needed long-term services and supports if they become functionally disabled, while providing them the opportunity to continue to live, work and participate in their communities.

The CLASS Act is supported by almost 100 national groups, including the Bazelon Center. See the letter to President Obama urging the inclusion of long-term services and supports in healthcare reform and, appended to the sponsors’ press release, a summary of the legislation. 

The bill sponsors note that 10 million Americans currently need long-term services and supports—a number expected to reach nearly 15 million by 2020. The cost of most private-sector disability or long-term care insurance plans is far from affordable, and neither Supplemental Security Insurance (SSI) nor the Old Age, Survivors and Disability Insurance (OASDI) program considers the extent and character of a disability in calculating benefits. Thus, most Americans who have or develop severe functional impairments must rely on Medicaid to access coverage for the services critical to their independence (such as housing modifications, assistive technologies, transportation and personal assistance services). But Medicaid eligibility rules that limit income and resources create a strong incentive for people who need long-term services to “spend down” assets and remain poor and unemployed.

Because Medicaid pays at least 50% of the cost for covered services, such a significant increase in the number of recipients of long-term services is expected to add $44 billion annually to the program’s cost over the next decade.

Additional information on the bill is provided here (see links at www.passtheclassact.org). The bills have been referred to the Senate Finance and House Energy and Commerce Committees.

Senate Bill Would Strengthen Protections for Juveniles

On March 24, Senate Judiciary Committee Chairman Patrick Leahy (D-VT), Ranking Member Arlen Specter (R-PA), and Senators Herb Kohl (D-WI) and Richard Durbin (D-IL) introduced S. 678, the Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009. The bill strengthens critical core protections for youth who are involved in or at risk of entering the juvenile justice system. It also provides for prevention, intervention and treatment services designed to reduce crime and recidivism among youth, including those with mental health and addiction needs.
Following are some of the ways the legislation strengthens core protections:

• Disproportionate Minority Contact (DMC): S. 678 provides guidance to states on specific steps toward reducing DMC, such as identifying and analyzing key decision points to determine where disparities exist, collecting data, developing a work plan and publicly reporting such efforts. Research has documented that youth of color are disproportionately over-represented and subject to more punitive sanctions than similarly charged/situated white youth at all levels of the juvenile justice system.
• Jail Removal and Sight and Sound:  S. 678 extends requirements to keep youth awaiting trial in criminal court out of adult lock-ups and to ensure sight and sound separation in the limited circumstances where they are held in adult facilities.  Research shows that youth confined in adult jails and lock-ups are at a pronounced higher risk of suffering assault and committing suicide and, upon release, are more likely to re-offend. 

The legislation also makes improvements to the overall juvenile justice system by:

Creating a new incentive grant program for states to employ empirically sound prevention and intervention approaches and improve their work in the areas of workforce development and diversion for youth with mental health and substance abuse needs.

• Improving conditions of confinement in juvenile facilities. S. 678 calls for the Office of Juvenile Justice and Delinquency Prevention (OJJDP) Administrator to report annually on states’ use of isolation and restraints in juvenile detention and corrections facilities and encourages training of facility staff to eliminate dangerous practices. The bill also calls for states to develop policies and procedures to eliminate dangerous practices and unreasonable use of restraints and isolation by using alternative behavior management techniques. 
• Providing comprehensive services and supports for youth. S. 678 promote alternatives to detention, improves screening, diversion, assessment and treatment for mental health and substance abuse needs, enhances child welfare and juvenile justice system integration, supports effective assistance of juvenile counsel, and improves case management and transitional services for youth upon re-entry.

For additional information, please see Chairman Leahy’s statement and a section-by section summary of the legislation.

The Bazelon Center supports the legislation. As an update, tt has been referred to the Judiciary Committee.

Ending Medicare’s Two-Year Waiting Period

Bills have been introduced in the House and Senate (S. 700 and H.R. 1708) to end the two-year waiting period for individuals on SSDI to receive healthcare through Medicare. Unlike those who qualify for Medicare based on age or certain life-threatening illnesses, SSDI beneficiaries currently face a 24-month wait before receiving Medicare coverage.

The Ending the Medicare Disability Waiting Period Act of 2009, sponsored by Senator Jeff Bingaman (D-NM) and Representative Gene Green (D-TX) would phase out the discriminatory waiting period from 2010 through 2014. The waiting period would be completely phased out by January 1, 2014.

The Bazelon Center supports the legislation and, in advocating for healthcare reform, is recommending that SSDI beneficiaries be allowed to receive the same immediate Medicare coverage as other eligible individuals: people over 65 and those who fall within the exception because of illnesses such as end-stage renal disease or amyotrophic lateral sclerosis.

The legislation has been referred to the Senate Finance and House Ways and Means Committee

National Criminal Justice Commission Proposed

Senator Jim Webb (D-VA) introduced legislation (S. 714) to create a National Criminal Justice Commission. The Commission would undertake a comprehensive review of the criminal justice system and make findings related to current federal and state criminal justice policies and practices. It would make recommendations to the President, Congress and state governments to improve public safety, cost-effectiveness, overall prison administration and fairness in the implementation of the nation's criminal justice system.

Recommendations for changes in policies and laws would include those designed to “improve and streamline the treatment of mental illness, both in our society and in the criminal justice system.”

Co-sponsors include Senators Richard Durbin (D-IL), Patrick Leahy (D-VT), Harry Reid (D-NV), Charles Schumer (D-NY),  Arlen Specter (R-PA), Lindsay Graham (R-SC), Mark Warner (D-VA), Patty Murray (D-WA),  Ron Wyden (D-OR), Kirsten Gillibrand (D-NY), Roland Burris (D-IL),  Sherrod Brown (D-OH), Edward Kennedy (D-MA), Kay Hagan (D-NC), Benjamin Cardin (D-MD, Jeff Bingaman (D-NM), Sheldon Whitehouse (D-RI), Mary Landrieu (D-LA) and Claire McCaskill (D-MO). 

Newsbytes

• Early Experience Matters: New ZERO TO THREE Guide

ZERO TO THREE recently released a new comprehensive policy guide, Early Experiences Matter: A Guide to Improved Policies for Infants and Toddlers, a comprehensive set of tools for use by policymakers and advocates.

The Policy Guide includes:

• Eleven concise issue briefs which support ZERO TO THREE’s policy agenda of Good Health, Strong Families, Positive Early Learning Experiences and Systems Building;
• Infant-toddler data to inform the policymaking process;
• A compilation of the evidence for investing in the infant-toddler policy agenda;
• A strategic look at ways to get started, with sample policy options and state examples; and
• In-depth issue papers and policymaking tools

The Early Experiences Matter Policy Guide was developed with the generous support of the A. L. Mailman Family Foundation and the Carol Berman Fund. It is available for download from the ZERO TO THREE website, www.zerotothree.org/policyguide

• OJJDP Releases 2008 Annual Report

The Office of Juvenile Justice and Delinquency Prevention (OJJDP) has released its 2008 Annual Report. The report provides information on OJJDP's activities in fiscal year 2008 to promote early intervention and delinquency prevention, support faith-based and community organizations, expand mentoring, improve the juvenile justice system, ensure public safety, curb child exploitation, combat youth gangs and serve tribal youth. The report concludes with an overview of the Office's information dissemination efforts.

To access OJJDP's 2008 Annual Report, visit http://www.ojjdp.ncjrs.gov/publications/PubAbstract.asp?pubi=247013.

• New Guide on Community Corrections and People with Mental Illnesses

The Council of State Governments Justice Center has released a new guide, Improving Outcomes for People with Mental Illnesses under Community Corrections Supervision: A Guide to Research-Informed Policy and Practice.  The guide reviews the body of recent research on community corrections supervision for people with mental illnesses and translates the findings to help officials develop effective interventions. It indicates that an unprecedented number of individuals under community corrections supervision have a serious mental illness. According to the Center’s press release, “these individuals are more likely than others to have their community sentences revoked, return to jail or prison, and become more deeply involved in the criminal justice system.”

The Guide can be viewed at: http://consensusproject.org/downloads/community.corrections.research.guide.pdf

• NCD Annual Report to the President and Congress 

The National Council on Disability released its annual report to the President and Congress on March 31, calling for a new, integrated approach to federal disability policy. The report provides 17 recommendations to address a range of pressing disability concerns and also provides principles to promote a more integrated approach to federal disability policy.

The report, National Disability Policy: A Progress Report, is at http://www.ncd.gov/newsroom/publications/2009/Progress_Report.doc.