106th Congress Produced New Programs, Mental Health Funding

Other Important Initiatives Left Unaddressed

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January 18, 2001—Weeks after the national elections and well beyond the October 1, 2000, start of the 2001 fiscal year, Congress finally adjourned, having reached agreement on an omnibus appropriations bill to fund the Department of Health and Human Services (H.R. 4577, conference report 106-1033).

The Center for Mental Health Services (CMHS) in the Substance Abuse and Mental Health Services Administration (SAMHSA) fared well in the 106th Congress. It won funding boosts and several new programs, including jail diversion, integrated treatment for co-occurring disorders, and rules on restraint and seclusion. The newly authorized programs are included in Public Law 106-310, the Child Health Act (see the Bazelon Center's October 4, 2000 Legislative Update).

Despite these successes, many other health issues important to the mental health and disability community were left unfinished when Congress adjourned on December 15, 2000. With a new Administration and a close majority in both houses, it is hard to know how these issues will fare after the 107th Congress convenes later this month.

Mental Health Well-Funded

The mental health block grant was increased significantly, lifting the total to $420 million. The $64-million increase for the 2001 fiscal year comes on the heels of last year's historic increase of more than 23%. This is another victory for the Bazelon Center and other national mental health organizations who continue advocating for new money to adjust for the decline in funds since the block grant's enactment in 1981. Continued increases will help states better serve adults with serious mental disorders and children with severe emotional disturbances through psychiatric rehabilitation, comprehensive wraparound programs and other community services.

Other important CMHS programs also received boosts.

• The children's mental health program, which funds comprehensive systems of community-based care, received $9 million more, bringing its total to $91.7 million.
• The PATH program of grants for states to provide services to people with severe mental illnesses who are homeless or at risk of being homeless, is now at $36.8 million (an increase of $6 million).
• The Protection and Advocacy (P&A) System that provides legal assistance to people with mental disorders in institutions was increased by $5.1 million, for a new total of $30 million. The $30-million figure is important because it allows the state P&A systems to begin serving individuals who live in the community. Under the SAMHSA reauthorization bill (Public Law No. 106-310), P&As assisting people with mental illnesses—until now limited by law to assisting people residing in or recently discharged from institutions—are authorized to assist individuals living in community settings once federal appropriations reach $30 million a year. The change will enable P&As to, for example, assist children with severe emotional disorders in special education cases or adults with mental illnesses in challenges to housing discrimination.
• The fiscal year 2001 appropriation agreement also increased CMHS' discretionary grant program by $67 million. Of many earmarks associated with this program, $90 million will be used to continue the "Safe Schools Healthy Students" anti-violence initiative, expanding mental health services for school children.
• Another $3 million has been earmarked for suicide prevention hotlines.
• $10 million is to develop knowledge of best practices for psychiatric disorders as a result of experiencing and witnessing trauma and to provide mental health services to children and youth suffering from such disorders.
• And $2 million was allocated for professional training in the use of restraint and seclusion in residential and day treatment centers for children and youth.

Support for Jail Diversion Continued

Although not specified by a dollar amount, some new funds appropriated under this authority are to be used to continue SAMHSA's support for jail diversion programs for non-violent mentally ill ofenders and for grants to local communities to improve mental health screening and referrals in non-mental health settings.

In 1997, SAMHSA, under this discretionary grant authority, began a three-year study of the effectiveness of jail diversion programs for adults with mental illnesses by funding nine sites across the country. With these new funds and the new jail diversion grant program authorized by Public Law No. 106-310, SAMHSA can continue its commitment to fostering successful models of jail diversion throughout the country. Outcome data on the nine sites is expected in 2001.

Issues Left on the Table

Many important issues remained unresolved and others were left in committee. Although some proposals will be re-introduced by their House and Senate sponsors, it is not yet clear what the new Administration and the next Congress will prioritize. The outstanding issues include:

Family Opportunity Act (S. 2274/H.R. 4825)
The Family Opportunity Act would create a state option under Medicaid to allow a buy-in by "middle class" families with children with severe disabilities, including serious emotional disturbance. The bill would also provide a legislative fix to the Medicaid home- and community-based waivers (Section 1915(c)) to allow children with psychiatric disabilities to receive intensive services in the community in order to avoid residential treatment.

Advocates hailed this bill because it would help end a perverse situation common in about half the states: When parents have no insurance or have insurance that does not meet their child's mental health needs, to get mental health services for their child they have to relinquish custody of the child to the child welfare system or impoverish themselves to stay under the Medicaid income guidelines so their child can access mental health services through Medicaid.

Although the bill had bipartisan support in both houses and was endorsed by the Administration, and was one of President Clinton's "end game" negotiation items, it ultimately failed because of opposition by the Republican leadership to expanding Medicaid.

Mental Health Parity
Mental health parity bills in both House (H.R. 1515) and Senate (S. 796) stalled in committee. Senator James Jeffords (R-VT), Chair of the Health Education, Labor and Pensions Committee, held a hearing on implementation of the 1996 Mental Health Parity Law, which became effective in Jan 1998 and expires on September 30, 2001. Mental health advocates will press for eliminating the law's sunset requirement and expanding it to provide for full parity for all individuals with a mental health disorder.

Medical Record Privacy
Final privacy rules were released by the Department of Health and Human Services on December 22, 2000 to meet the deadline imposed by the 1996 Health Insurance and Portability Accountability Act. The final rules improve on the draft in many respects. They apply to electronic records, paper records and oral transmission of information by any entity that uses electronic means to transmit health information. However, because these rules do not provide for a private right of action for breaches of privacy, legislation will be needed for consumers to enforce their rights in federal courts. A summary of the final privacy rules will be posted on the Bazelon Center's website in mid January.

Medicare Prescription Drugs
Efforts to provide a prescription drug benefit for Medicare beneficiaries collapsed, felled by competing ideas of how to provide the benefit. Early on, the House approved a Republican plan (H.R. 4680) that would subsidize insurance companies to induce their participation in offering drug benefits. However, the bill was ultimately scuttled by criticism from the health insurance industry, opposition from congressional Democrats who want to incorporate the drug benefit in Medicare and veto threats from the President.

Managed Care Reform
Although providing enforceable patient protections to individuals with private health insurance remained a priority for the Clinton Administration and numerous consumer groups, a final "meaningful" bill did not pass this session. The conference committee chosen to reconcile differences between the House and Senate versions stalled on the issue of whether to hold an HMO liable for harm caused by the delay or denial of necessary care.

However, the Department of Labor recently released final regulations designed to improve the claims review and appeals procedures for individuals in ERISA (company-sponsored) group health plans, along with new rules on disclosure of health plan information (published in the Federal Register on November 21, 2000). These regulatory efforts will help consumers navigate the health insurance maze, although they do not meet the need for a federal law protecting consumers in managed care plans.

Juvenile Justice Legislation
Bills to revise federal juvenile justice laws were stalemated for most of the session over gun control provisions in the Senate bill (S. 254). Despite some successful mental health amendments, the underlying bills were very punitive for juveniles, including those with mental or emotional disorders. Both bills also contained a provision that would abrogate the right to a free and appropriate education, established by the Individuals with Disabilities Education Act (IDEA), for students who violate school rules about weapons. Advocates for children's rights, including the Bazelon Center, are seeking substantial changes before they will support a juvenile justice bill.

SAMHSA Reauthorized

The Bazelon Center has summarized changes to existing mental health programs in the Substance Abuse and Mental Health Services Administration and new SAMHSA mental health programs, established through enactment of Public Law 106-310, the Child Health Act.