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. 6, August 5, 2009

Congress’ Summer Break Offers Opportunities for Advocates

In this issue

• Health Care Reform is Hot Topic
  - What you can do
  - How mental health fits in
  - How these bills would affect people with mental health needs
• Sotomayor Confirmation Vote This Week
  
• Clock is Ticking for Parity Rules
• Prospects Looking up for Supportive Housing

Newsbytes

• US Signs International Convention on Disability
• Education Secretary Promotes Positive Behavioral Support to Reduce Restraint and Seclusion in Schools
• Lawsuit Settles to Create Supportive Housing in New Jersey
• Follow Bazelon on Facebook and Twitter!

Healthcare reform is occupying a heavy share of news coverage this summer and takes up much of this Reporter. With Congress delaying action until at least September, Senators and Representatives are being barraged by anti-reform groups and will be canvassing their constituents on the subject during their home stays in August. We urge you to let your lawmakers know that healthcare reform matters to you and that it is vital to include mental health coverage. The descriptions and links in the Reporter offer some points you can raise with them.

You have a month to reach your lawmakers on healthcare— and on an important Senate bill to increase the supply of housing for people with disabilities. But two items call for action today: the Senate vote to confirm Sonia Sotomayor as an Associate Justice of the U.S. Supreme Court—likely to take place this Thursday, August 6—and a Senators’ letter to be sent the same day to the three federal agencies responsible for issuing rules on mental health parity. Your calls to your Senators will help both of these efforts.

Healthcare Reform is Hot Topic for Summer Recess

On July 31, the House Energy and Commerce Committee favorably reported H.R. 3200, America’s Affordable Health Choices Act, on a 31-28 vote. (see Chairman Waxman’s press release and a list of national organizations supporting the bill. It was the last of the three House Committees with jurisdiction over healthcare reform legislation to mark up H.R. 3200, the Ways and Means and Education and Labor Committees having given approval on July 17, by 23-18 and 26-22 respectively. The House is now poised to bring a combined version to a floor vote when Congress reconvenes in September. 
Key Points in the House Healthcare Bill

• A Health Insurance Exchange, which would constitute a public brokerage through which uninsured individuals and small employers could purchase a private health plan or a new public insurance option.
• Standardized benefit packages that would make it easier for purchasers to select coverage based on cost and quality information. Exchange plans would be designed to harness the power of group purchasing and would be required to conform to standardized marketing and enrollment procedures, as well as new federal consumer protection standards.
• Insurance reforms ending discriminatory practices that often occur with mental illnesses, such as exclusions for pre-existing conditions and rates based on health status, gender or occupation.
• Expansion of Medicaid to households with incomes below 133 percent of the federal poverty level.
• Requirements that all plans have mental health and substance use treatment and that this coverage must be at parity (i.e., equal to the coverage of other conditions).
• Individual affordability credits to help households with incomes up to 400% of the federal poverty level ($43,000 for individuals or $88,000 for families of four) for the cost of coverage and cost-sharing (co-payments and deductibles) at the time of service.   
• A cap on premiums and out-of-pocket spending, which would help to ease the burden on people who have frequent needs for health care services, drugs and supplies. 
• Elimination of co-pays or deductibles for preventive care. 
• A requirement that individuals obtain coverage or pay a penalty. Similarly, employers would have to either provide health insurance or pay a fee (eight percent of their payroll).

Across the Capitol in the Senate, a bipartisan group of six Finance Committee members (Chairman Max Baucus (D-MT), Ranking Member Charles Grassley (R-IA) and Senators Kent Conrad (D-ND), Mike Enzi (R-WY), Jeff Bingaman (D-NM) and Olympia Snowe (R-ME) continues negotiating a bill in hopes of winning over more Republicans. The negotiations are expected to continue through mid-September. The Senate Health, Education, Labor and Pensions (HELP) Committee approved its health reform bill (the Affordable Health Choices Act) on July 15, by a 13-10 vote. 

You can find summaries and links to the bills on our Healthcare Reform page.

Time to Act

With the August recess upon us, now is the time to contact your Senators and Representative to urge enactment of a strong, comprehensive healthcare reform bill this year. Both the House bill and the legislation approved by the Senate HELP Committee would extend affordable, quality health coverage to millions of Americans. It is time to make healthcare reform a reality. Your voice must be heard.

What You Can Do

Contact your Senators and Representative (phone or regular mail are best; if you use email, include your full postal address). Urge them to maintain the momentum to enact healthcare reform this year.

The month-long August recess is not a time to let Congress off the hook. Members are hearing plenty every day from industry lobbies and anti-reform groups. They need to hear from their constituents like you, who care about healthcare for millions of Americans.

How Mental Health Fits In

The Bazelon Center’s policy papers on integration of mental health in healthcare include the following recommendations, many of which have been included in the approved committee bills.

• Provide affordable access to health and mental health coverage for all Americans. 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 access to proven prevention and early intervention services, particularly for very young children.
• Include attention to mental health disorders in all chronic-care programs, such as those for diabetes, asthma, heart disease and cancer, in order to treat co-occurring mental disorders.
• Strengthen and expand Medicaid coverage, including eligibility for single, childless adults at or below the federal poverty level, coverage of therapeutic foster care services as a Medicaid-reimbursable service for children who would otherwise be placed in Medicaid psychiatric residential centers and maintenance of comprehensive benefits.
• Include access to long-term services and supports, and allow individuals who have psychiatric disabilities to benefit.

How These Bills Would Affect People with Mental Health Needs

The Bazelon Center regularly updates summaries of how H.R. 3200 and the Senate committee bills affect individuals with mental illnesses. Some specific examples:

• Representative Tammy Baldwin (D-WI) championed an amendment to clarify Medicaid reimbursement for (and define) therapeutic foster care services. It was accepted by voice vote on July 30 in the House Energy and Commerce Committee. Medicaid therapeutic foster care is a cost-effective, evidence-based service that provides an intensive, out-of-home therapeutic environment in a least restrictive setting for youth with severe mental, emotional or behavioral disorders.

• Representative Frank Pallone (D-NJ) offered an amendment spearheaded by Representatives Doris Matsui (D-CA) and Eliot Engel (D-NY) to establish a definition of and provide standards for community mental health centers and other community programs electing to become certified as Federally Qualified Behavioral Health Centers. The amendment was accepted by voice vote on July 20 by the House Energy and Commerce Committee.

• On July 20 the Energy and Commerce Committee adopted by voice vote long-term care provisions that would establish a national voluntary insurance program for purchasing community-living assistance services and supports. The provisions reflect the work of Representative Frank Pallone (D-NJ) and Senator Edward Kennedy (D-MA) on H.R. 1721 and S. 697, The Community Living Assistance Services and Support (CLASS) Act. 
  
  
• Representative Bobby Scott (D-VA) championed an amendment that would establish well-baby, well-child care and Early and Periodic Screening, Diagnostic and Treatment services (EPSDT) for children under age 21 participating in the insurance exchange. The amendment was approved 32-17. Under the House bill, the State Children’s Health Insurance Program would expire September 30, 2013. The amendment would secure access to medically necessary services for kids moving into the exchange at that time.

• An amendment championed by Representative Christopher Murphy (D-CT) provides for suspension (rather than termination) of Medicaid benefits for incarcerated youth and would ensure that eligible youth transitioning to the community upon release can access Medicaid services without delay.  The amendment was offered on July 30 in the Energy and Commerce Committee and approved by voice vote.
  
  
• On July 14 the Senate HELP Committee approved by 14-9 an amendment to authorize grants for the co-location of primary and specialty medical care in community-based mental health settings. The amendment stems from S. 1188 and H.R. 1011, the Community Mental Health Services Improvement Act, sponsored by Senators Jack Reed (D-RI), Lisa Murkowski (R-AK) and Sheldon Whitehouse (D-RI) and Representatives Gene Green (D-TX) and Tim Murphy (R-PA).  The Mental Health Liaison Group endorsed this amendment in a letter to Senator Reed.

• Representative Betty Sutton (D-OH) spearheaded an amendment that would include the Substance Abuse and Mental Health Services Administration in the list of agencies that the Secretary of the Department of Health and Human Services must consult with when developing a national prevention and wellness strategy. This amendment was approved by the Energy and Commerce Committee by voice vote on July 20.

Senate Vote Imminent on Supreme Court Nominee

The Senate will vote this week—likely Thursday, August 6—on the historic nomination of Judge Sonia Sotomayor to the United States Supreme Court.  If confirmed, Judge Sotomayor would be the first Hispanic justice and only the third woman and third person of color on our nation’s highest court.  Notably, she is also a person with a disability, insulin-treated diabetes.

Most important, Judge Sotomayor has a sterling record in disability rights cases.  Her decisions under the Americans with Disabilities Act (ADA), the Rehabilitation Act, the Individuals with Disabilities Education Act, and other disability rights laws demonstrate her understanding of and respect for the rights of persons with disabilities. Her careful and thorough approach to the facts and law in these cases indicates her appreciation for Congress’ intent, reaffirmed last year in the ADA Amendments Act, that these laws contain strong protections for people with disabilities.

What You Can Do—Right Now!

Please call your Senators today to make sure they vote for Judge Sotomayor for the Supreme Court.  Why? Although some have said that Judge Sotomayor’s confirmation is a “sure thing,” no confirmation is certain until all 100 Senators cast their votes. It is also important that Judge Sotomayor is confirmed with as many votes as possible—to send President Obama a message that he should nominate more judges to the federal courts who have excellent records on disability rights.

Only a few Senators have not said how they will vote this week.  It’s especially important that these Senators hear from people with disabilities, to urge them to vote for Judge Sotomayor. They need to know that people with disabilities are watching!

Still on the fence:
Senator Mark Begich (Alaska), (202) 224-3004
Senator Lisa Murkowski (Alaska), (202) 224-6665
Senator Judd Gregg (New Hampshire), (202) 224-3324
Senator George Voinovich (Ohio), (202) 224-3353
Senator Mike Enzi (Wyoming), (202) 224-3424

The Clock is Ticking for Mental Health Parity Regulations

For health plans to fully comply with the historic mental health parity law enacted last year (Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act, P.L.110-343), federal regulations are needed. The law requires the Secretaries of the Department of Health and Human Services, the Department of Labor and the Treasury to issue implementing rules before the effective date (for plan years beginning after October 3, 2009 and calendar year plans, January 1, 2010).

With three agencies involved in what can be a lengthy approval process, expeditious action is critical. Earlier this year, the agencies issued a request for information (RFI) from the field, but rules have yet to be released. See the Bazelon Center’s May 26 Action Alert for a link to our comments on the RFI.

Senators Al Franken (D-MN), Edward Kennedy (D-MA), Jack Reed (D-RI) and Sheldon Whitehouse (D-RI) have authored a Dear Colleague sign-on letter in response to this concern. The deadline for Senators to endorse the letter is 5 pm on August 6 so the letter can be sent at the start of the Senate recess.

What You Can Do

Call your Senators today and urge them to sign on to the letter from Senators Franken, Kennedy, Reed and Whitehouse so that consumers requiring mental health and addiction services will be assured of parity when accessing services. The letter will be sent to the agencies at the start of the Senate recess

Prospects for Supportive Housing Looking Up

On July 23, 2009, the House of Representatives overwhelmingly passed groundbreaking bipartisan legislation that will significantly change and improve the Section 811 Supportive Housing for Persons with Disabilities program. The votes on the Frank Melville Supportive Housing Investment Act included 376 ayes, 51 nays, 6 present/not voting. The bill now goes to the Senate for consideration.

An identical bill, S. 1481, was introduced in the Senate on July 21 by Senator Robert Menendez (D-NJ), Chair of the Senate Banking, Housing and Urban Affairs Subcommittee on Housing and Transportation. The Senate bill is co-sponsored by Senator Mike Johanns (R-NE), also a member of the subcommittee.

Section 811 is a critical federal program that assists the lowest income Americans with serious and long-term disabilities to live independently in the community by providing integrated affordable rental housing linked with voluntary services and supports. The Melville Act will spur creation of thousands of new 811 units every year by authorizing a new and innovative Project Rental Assistance Demonstration Program that fulfills the promise of true community integration as envisioned in the Americans with Disabilities Act.

The Demonstration Program will provide rental subsidiesneeded to create small set-asides of supportive housing units (e.g., 5%) for people with disabilities and SSI-level income in the hundreds of thousands of high-quality affordable rental housing developments produced routinely by state and local governments.  Through the Demonstration Program, the new legislation will change the basic Section 811 model, which for 30+ years has produced small group homes and single-population independent living facilities but no longer responds to the housing needs and choices of most people with disabilities, who prefer to live in housing that is truly integrated within local communities.

What You Can Do

Contact your Senators while they are home during the August recess and let them know that low-income people with disabilities desperately need the housing that would be provided by Section 811. Urge them to co-sponsor S.1481 now and ultimately vote to enact it.

Newsbytes

United States Joins UN Convention on the Rights of Persons with Disabilities

On July 30, the United States joined 141 other nations in signing the United Nations Convention on the Rights of Persons with Disabilities. Health and Human Services (HHS) Secretary Kathleen G. Sebelius noted that in signing on, the US “sends an important message that this country is committed to equal rights for people with disabilities, in the United States and around the world.” 

Secretary Sebelius also cited as “another important example of our commitment” the President’s launch of the Year of Community Living in June.  HHS has already begun to carry out the initiative, she said, by establishing an HHS Coordinating Council, led by the Office on Disability. The council includes the Administration on Aging, the Centers for Medicare & Medicaid Services, the Office for Civil Rights, the Office of the Assistant Secretary for Planning and Evaluation, the Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration, the Administration for Children and Families, and the Office of Public Health.

“HHS is proud to support the Convention on the Rights of Persons with Disabilities, the first new UN human rights convention of the 21st century,” the Secretary said. “We look forward to advancing dignity, autonomy, full inclusion, and equality of opportunity for Americans, and for people with disabilities around the world.”

Education Secretary Urges State School Chiefs to Review Policies on Restraint and Seclusion

On July 31, Education Secretary Arne Duncan sent a letter to chief state school officers in response to the congressional hearing on the use of restraint and seclusion in our nation’s schools. (See the Bazelon Center’s May 27 Mental Health Reporter for more information on the hearing at http://www.bazelon.org/newsroom/reporter/2009/5-27-09reporter.htm#1).

The letter discusses positive behavior interventions and supports in the context of restraint and seclusion use and urges the state school officers to develop or review and, if appropriate, revise state policies or guidelines to protect students from unnecessary and inappropriate use of restraint and seclusion.

Secretary Duncan pointed out that the American Recovery and Reinvestment Act provides significant one-time resources that districts can use to implement a school-wide system of positive behavioral intervention and support (PBIS). He reminded school officers that PBIS “can increase the capacity of the school staff to support children with the most complex behavioral needs, thus reducing the instances that require intensive interventions” such as seclusion or restraint. Some 8,000 schools across the country are already implementing PBIS, he noted.

New Jersey Hospital Residents See Supportive Housing in their Future

The New Jersey Department of Human Services will release hundreds of people institutionalized for years in the state’s psychiatric hospitals and provide the services they need for independent, integrated living in the community. In a July 29 settlement with Disability Rights New Jersey, the state’s protection & advocacy agency, and the Bazelon Center for Mental Health Law, the state agreed to provide community residential services for approximately 300 people who have been awaiting discharge since before July 1, 2008. The state will also develop 1,065 new supportive housing units and other similar community settings between now and 2014 to eliminate the backlog of hospital residents awaiting discharge and to prevent a recurrence of the problem.  

Supportive housing will give these individuals their own apartments while providing the services they need to support their recovery and community involvement. Research shows that supportive housing is less costly, leads to more improvements in mental health symptoms, and is highly preferred by participating individuals over other types of housing for people with mental disabilities.  

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