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. 5, July 9, 2009

Healthcare Reform Tops Congressional Agenda

Grassroots Action Needs to Intensify

In this issue

• Healthcare Reform is at a Critical Stage
• Mentally Ill Offender Grant Program Funding at Issue
• Help for Transition-Age Youth
• Recidivism-Reduction Act Introduced
• Medicaid Services Restoration Act Reintroduced
• Sotomayor Nomination Hearings to Begin

Newsbytes

• CMS Rescinds Medicaid Final Regulations
• Grassroots Stories Support Healthcare Reform; Will You Add One on the Need to Include Mental Health?

Two big stories dominated national news this week: healthcare reform and the nomination of Judge Sonia Sotomayor to the U.S. Supreme Court. Here you'll find details on both, plus updates on other important congressional actions. In the realm of criminal justice, these include a difference between House and Senate allocations of funding for state collaborations to reduce incarceration and a bill to ease the transition to community living for offenders upon release from jail or prison, particularly if they have mental illnesses. Another new bill would help to keep youth with mental health conditions from falling through the cracks as they transition into adulthood. Some good news comes, to no one's surprise, in initiatives by both Congress and the Department of Health and Human Services to restore and clarify important Medicaid services needed by children and adults with mental disabilities.

Healthcare Reform is at a Critical Stage

Five committees in the two chambers of Congress are fully engaged in work to enact comprehensive healthcare reform legislation this year. The Senate Health, Education, Labor and Pensions (HELP) Committee is continuing review of its “Affordable Health Choices Act” and the Senate Finance Committee will soon release its proposal, as Chairman Max Baucus (D-MT) works to release a bipartisan bill. The House has held several hearings on its Tri-Committee (Energy and Commerce, Education and Labor, and Ways and Means) proposal in preparation for markup of a bill, expected next week. See the Bazelon Center’s updated summaries of these bills.

Enacting strong, comprehensive healthcare legislation this year will require ample and intense grassroots action. It is essential for members of Congress to hear from you about the importance of extending affordable, quality health coverage to millions of Americans — without delay.

What You Can Do

Contact your Senators and Representative now and urge them to enact strong, comprehensive healthcare reform legislation this summer. Remind them that mental illness is the leading cause of disability in the United States for people between the ages of 15 and 44, and that mental health is part of health and must be addressed in an integrated manner.

With respect to integration of mental health into health systems, healthcare reform should:

• Provide access to health and mental health care coverage for all. All Americans should qualify for healthcare services they can afford, including mental health care. Mental health services must be a part of any health plan’s benefit and provided at parity with other healthcare. Individuals with severe mental illnesses must have access to the range of rehabilitation services that enable them to function better.
  
  
• Integrate mental health into primary care settings for both children and adults. Co-location of primary care and specialty behavioral health practitioners or collaborative care should be encouraged. Primary care mental health services should also be adequately reimbursed. Incentives must be provided to expand medical homes and similarly organized systems of care that include behavioral health specialists. Public mental health agencies should be eligible to become medical homes to address the complex needs of individuals with severe mental illnesses.
  
  
• Expand early intervention and encourage evidence-based prevention activities that include mental health. Incentives must be adopted to ensure that proven prevention and early intervention services are provided, particularly for very young children. Quality of care is improved through the expansion of evidence-based practices.
  
  
• Include attention to mental health disorders in programs of chronic-care management. Mental health services should be integrated into all chronic-care programs, such as those for diabetes, asthma, heart disease and cancer, in order to treat co-occurring mental disorders.
  
  
• Include access to long-term services and supports, with individuals who have psychiatric disabilities able to benefit.

A letter by Representative Mary Bono-Mack (R-CA), as vice-chair of the Congressional Addiction Treatment and Recovery Caucus, to House Energy and Commerce Chairman Henry Waxman (D-CA) and Health Subcommittee Chairman Frank Pallone (D-NJ) urges inclusion of mental health and substance use services in health reform legislation.

See How to Contact Your Lawmakers.

Mentally Ill Offender Act Funding Increase at Issue

The House would increase funding for the Mentally Ill Offender Act by $2 million over fiscal year 2009 (H. Rept 111-149) while the Senate Appropriations Committee has proposed level funding at $10 million for fiscal year 2010. The program provides grants to help states and localities address the growing rate of incarceration of people with mental illnesses by developing collaborative mental health and criminal justice responses to such offenders. Grants are flexible, allowing grantees to create or expand programs that intervene at any point in the continuum of criminal justice contact (pre-booking, post-booking, mental health courts and other court-based approaches, re-entry and transitional programs), including funding crisis intervention teams and providing law enforcement training. 

The Senate has yet to act on the appropriations bill with jurisdiction over the program. Ultimately a conference between the House and Senate will determine final funding levels. Members of both houses signed a letter to the Appropriations Committee chair expressing support for increased funding.

Help for Transition-Age Youth with Mental Health Conditions

Legislation to keep youth with mental health conditions from falling through the cracks as they transition into adulthood has been reintroduced by Representatives Pete Stark (D-CA), Mary Bono-Mack (R-CA) and Dave Camp (R-MI). The Healthy Transitions Act of 2009 (H.R. 2691) would establish grants to help states develop and execute coordinated plans to give adolescents and young adults with a serious mental health disorders the tools they need to make a healthy transition to adulthood. The bill would also establish a committee of federal partners to coordinate the multitude of federal programs that assist adolescents and young adults with mental illnesses (see the Bazelon Center’s fact sheets, Moving On). The committee would also provide technical assistance to states and report back to Congress.

The legislation is supported by the Mental Health Liaison Group (see letter). It addresses findings by the Government  Accountability Office that 2.4 million young adults had a serious mental illness in 2006 and encountered difficulty finding services to help them during transition to adulthood. The bill has been referred to the House Energy and Commerce Committee.  For further information please visit:  

For the bill text, please visit: http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.2691:

For Rep. Stark's floor statement introducing the bill, please visit:
http://www.stark.house.gov/index.php?option=com_content&task=view&id=1287&Itemid=84

What You Can Do

Contact your Representative and urge him or her to co-sponsor H.R. 2691. Adapt language from the MHLG letter if you wish. You can find a current list of Representatives who are supporting the legislation at http://thomas.loc.gov (enter the bill number in the search box).

Recidivism Reduction Act Introduced

Representatives Andre Carson (D-IN), Patrick Kennedy (D-RI) and Pete Stark (D-CA) have introduced the Recidivism Reduction Act (H.R. 2829). The legislation would provide timely restoration of federal disability benefits (SSI, SSDI and Medicaid) to eligible individuals upon release from incarceration. Its goal is to ease offenders’ transition back into society, especially for those who have mentally illnesses. Prompt access to disability and medical benefits upon release is essential for access to needed treatment, housing and other critical services and support that can help avoid the cycle of recidivism.

Currently, due to barriers in federal law, it takes considerable time—up to several months— to reinstate benefits. H.R. 2829 would address this delay and help foster successful transitions into the community by:

• Providing provisional benefits on the day of release from prison for eligible individuals whose benefits were suspended. The Social Security Administration (SSA) would then check non-disability factors. Should the person prove ineligible, benefits would be stopped.
  
  
• Providing provisional benefits for eligible individuals being released from jail or prison if benefits have been terminated for no more than 36 months.
  
  
• Increasing the federal match for states to update their computer systems so that they can suspend, rather than terminate, Medicaid benefits for inmates. The bill also provides for immediate reinstatement of Medicaid upon release for individuals who were enrolled prior to incarceration. 
  
  
• Allowing for up to three case management services to be provided to incarcerated individuals in order to engage in planning for services following release.
  
  
• Providing for a pre-release program for SSDI recipients identical to that now in place for SSI.

(See Rep. Carson’s press release for more information.)

The legislation has been referred to the House Ways and Means Committee and House Energy and Commerce Committee.

What You Can Do

Contact your Representative and urge him or her to co-sponsor HR 2829. You may want to adapt the language in a letter endorsing H.R. 2829 by national advocacy groups, including the Bazelon Center.

Medicaid Services Restoration Act

Senator Debbie Stabenow (D-MI) has reintroduced the Medicaid Services Restoration Act (S.1217) with Senators March Begich (D-AK) and Blanche Lincoln (D-AR). The legislation would:

• Create a new service category to finance therapeutic foster care for children with serious mental and emotional disturbances. Therapeutic foster care is the least restrictive form of out-of-home placement for children with serious mental disorders, and would keep children in their home community. Trained surrogate parents provide a structured, therapeutic environment where children receive intensive individualized Medicaid psychiatric rehabilitation services and learn coping skills and how to manage the symptoms of their illness.
  
  
• Help individuals with disabilities attain and retain functional skills by authorizing “habilitation” services under the rehabilitation option.
  
  
• Allow states to use bundled rates to pay for services through the rehabilitation option instead of, as CMS insists, accounting and billing for services in 15-minute increments. Although not specifically described in the rehabilitation regulation, this denial of payment through daily rates, case rates and similar arrangements severely restricts providers’ ability to provide evidence-based practices like assertive community treatment and multi-systemic therapy. The legislation would also permits efficient and reasonable payment methodologies under the case management and targeted case management option.
  
  
• Authorize Medicaid to pay for physical health care for children who are placed in a 24-hour psychiatric hospital or psychiatric residential treatment center that provides Medicaid psychiatric inpatient services for children under 21. This change addresses CMS’ claims that Medicaid law applies only to mental health services provided to children in these facilities, contradicting Medicaid’s EPSDT requirement that a Medicaid-eligible child receive “all medically necessary services” under a state plan.
  
  
• Codify the Olmstead case management standard that permits 180 days of intensive case management services for Medicaid beneficiaries with disabilities who are transitioning from institutions to the community.
  
  
• Authorize states to assign case managers to individual Medicaid beneficiaries, including multiple case managers.

For more information, see a summary prepared by the Child Welfare League. The legislation was first introduced in the last Congress, in response to harmful Medicaid regulations issued by the Bush Administration (see the Bazelon Center’s October 26,2008 Policy Reporter). Although the Obama Administration has rescinded the regulations (see newsbyte), the legislation makes meaningful improvements to Medicaid.

Hearings on Sotomayor Nomination to Begin; Vote Likely in August

The Senate Committee on the Judiciary plans to open hearings on President Obama’s nomination of Judge Sonia Sotomayor to the U.S. Supreme Court on Monday, July 13. The Bazelon Center and more than two dozen other disability groups sent a letter to the committee leadership, endorsing the nomination, noting that “Judge Sotomayor’s decisions under our seminal civil rights law, the Americans with Disabilities Act (ADA), have demonstrated a good understanding of – and healthy respect for – the rights of persons with disabilities.” See also a review of Judge Sotomayor’s many decisions involving the rights of people with disabilities.

The hearing is expected to last all week, with a floor vote likely in early August to meet the President’s desire that the new associate justice be sworn in well before the start of the court’s term in October.

What You Can Do

• If one of your Senators is on the Judiciary Committee, call now to urge him or her to support Judge Sotomayor’s nomination (see list with phone numbers in our latest Action Alert, Five Things You Should Know about Judge Sonia Sotomayor and Disability Rights).
• If not, write to both of your Senators urging them to vote for Judge Sotomayor’s confirmation when her nomination comes to the floor in a few weeks.

Newsbytes

Harmful Medicaid Rules Rescinded

The Department of Health and Human Services has officially rescinded all or part of the Medicaid regulations that were issued in final form under the Bush Administration and suspended by Congress (see CMS press release). The rules that were rescinded include all of the Medicaid regulations governing school-based administration and transportation services, all of the rule limiting outpatient hospital and clinic services and part of the December 4, 2007 rule that would restrict access to case management services.   

The rules were suspended by a congressional moratorium that was set to expire on July 1, 2009 (see the Bazelon Center’s July 7, 2008 Alert). The Department had released a notice of proposed rulemaking to rescind the three rules earlier this year and was expected to publish the final regulation rescinding the rules prior to expiration of the moratorium. 

Grassroots Stories Support Healthcare Reform; Will You Add One on the Need to Include Mental Health?

“Health Care Stories for America” is the newest section on the Obama grassroots website, Organizing for America. It features an interactive map of the United States with links to stories people have sent to illustrate the dreadful problems with our current healthcare system. If you have a story (your own or another’s) that illustrates the dire need to integrate mental health with healthcare coverage in any reform —and to make coverage accessible and affordable—why not add it? A megaphone icon at bottom left of the page offers a way to boost the prospects of your story, or any other that you choose, of being featured on the map.

These stories will be invaluable to convince legislators and the public (remember the Harry and Louise commercials that sank health reform in 1993) of the need for real reform. If you submit a story, please copy it for the Bazelon Center, sending to leec @ bazelon.org (close the spaces).