Legislative Update: First Session of 108th Congress Adjourns with Little
Achieved
December 19, 2003-The 108th Congress adjourned its first
session accomplishing little for people with mental
disabilities. Longstanding mental health bills (the Family
Opportunity Act, mental health parity) and the
renewal of laws affecting individuals with mental disabilities (TANF, IDEA)
fell by the wayside this year. The Senate also failed to
approve a year-end mandatory spending bill that includes
funding for community-based mental health services and
programs.
Some members of Congress have expressed optimism about passage
of some of these proposals next year. However, it remains to be
seen what can be accomplished in an election year.
In this issue:
Public Mental Health Services Funded Modestly
The President's Commission on Mental Health highlighted
consumer-driven services and recovery in its report, but did
not urge the increased federal funding for public mental health
programs essential to realize these reforms. Advocates are
disappointed that Congress largely failed to increase funding
for programs and services administered by the Substance Abuse
and Mental Health Services Administration's (SAMHSA) Center for
Mental Health Services (CMHS) above the budget the President
submitted last February. However, Congress did opt to maintain
or increase grant funding in some programs the Administration
had proposed to freeze or cut.
This trend was evident in most of the grants in CMHS'
discretionary budget (Programs of Regional and National
Significance), including the jail-diversion program,
post-traumatic stress program, seniors mental health program,
and consumer-run technical assistance centers.
- The jail diversion program will receive $7 million, a $1-million increase
over the President's level funding. Funds help communities develop programs
to divert mentally ill
offenders from the criminal justice system into community-based
mental health treatment. Funding for the program has steadily
increased in the last three fiscal years ($4 million in FY
2002, $6 million in FY 2003 and $7 million in FY 2004). The
Bazelon Center and other mental health advocates hope to expand
the program further next year when Congress is scheduled to
reauthorize SAMHSA programs and services.
- The post-traumatic stress disorders program escaped the Administration's
proposed $10 million cut and will remain
funded at $30 million.
- The seniors mental health program will be level-funded at $5 million.
- The
consumer-run technical assistance centers will receive $2 million, despite
the Administration's attempts to eliminate the centers' funding.
Some Programs
Are Increased
The grant program to assist individuals who are homeless or at risk of being
homeless (PATH) will receive the largest increase
($6.7 million) of all CMHS programs, followed by the children's mental health
program, which was increased by $3.9 million. The legal assistance program
for individuals with mental disorders
administered by the protection and advocacy systems will
increase by $1 million over the FY 2003 level.
Congress Shrinks Cuts
Although the mental health block grant and the CMHS discretionary budget were
slated for cuts by the
Administration, Congress called for smaller reductions.
- The mental health block grant will be reduced by $2.4 million
rather than the $4.1 million proposed by the Administration.
- The discretionary budget (PRNS) will be cut by $3.6 million rather than
$32.7 million.
New Funding for Substance Abuse Treatment
Although the substance abuse block grant has typically received large increases,
the discretionary budget at SAMHSA's Centers
for Substance Abuse Treatment (CSAT) will receive the largest
increase (over $100 million) in fiscal year 2004.
This new funding is for a drug and alcohol treatment voucher
program, including faith-based programs. It will serve as a
competitive grant, allowing states flexibility to customize
programs based on the initiative's principles and policies.
States may contract entirely with private entities and accountability will
be linked to a demonstration of treatment effectiveness.
Senate Will Consider Overall Spending Next Year
Although the Senate has yet to approve the Omnibus Appropriations Act of Fiscal
Year 2004, (H.R. 2673) the funding
levels in the conference report will not likely change for
public mental health services (see chart). The Senate is
expected to resume consideration of the omnibus bill when it
reconvenes on January 20, 2003. For the moment, programs will
remain funded at fiscal year 2003 levels, under a resolution
set to expire on January 31, 2004.
TANF Renewal Held Over
Congress once again failed to reauthorize the 1996 welfare law,
which created the Temporary Assistance for Needy Families
(TANF) program. Current law was extended until March 31, 2004,
giving Congress more time to complete a bill.
A report last year by the General Accounting Office (GAO)
highlighted the challenges faced by many TANF recipients with
disabilities. It found that families with disabilities
(physical or mental) were half as likely to leave the TANF
rolls as recipients without disabilities. Similarly, families
caring for children with disabilities were less than half as
likely to leave the rolls. Renewal of the law must recognize
the barriers faced by this population and include provisions to
assist such recipients in successful transition to work.
Instead, the renewal bill quickly passed by the House was
similar to last year's House bill, mirroring the
Administration's proposal. It would undermine state flexibility
in giving TANF recipients with disabilities access to
assistance in finding and maintaining employment. It also has
stricter work requirements that could lead to unfair sanctions for these
recipients.
The Senate version, the Pathways to Independence Act (S.
1523),
was approved by committee, but did not come up for a floor
vote. Sponsored by Senators Gordon Smith (R-OR), Jim Jeffords
(I-VT) and Kent Conrad (D-ND), the bill would help families
care for children or adult relatives with disabilities. It
would also allow states to provide assistance to TANF
recipients with disabilities who need mental health or
substance abuse treatment beyond six months, as long as they
also engage in some work activity. Disability advocates will
continue to build support for this important legislation next
year in hopes of influencing both the Senate debate and a final
TANF bill.
Mental Health Parity Extended
Legislation to provide full
parity between mental health and medical/surgical care stalled
again. However, passage will remain a high priority next year.
In fact, prior to adjournment, Senate sponsors were able to
secure a commitment from the Republican leadership to bring
parity up as one of the first bills on the Senate floor in the
new session. Until then, existing law has been extended until
December 31, 2004.
The Senator Paul Wellstone Mental Health
Equitable Treatment Act (S. 486, H.R.
953) is cosponsored by
Senators Pete Domenici (R-NM) and Edward Kennedy (D-MA) and
Representatives Jim Ramstad (R-MN) and Patrick Kennedy (D-RI).
It builds on the 1996 Parity Act that requires equal lifetime
and annual financial limits.
The new legislation would require parity for plans sponsored by employers
with more than 50 employees who already provide
mental health benefits. It expands the 1996 law to prohibit
limits on outpatient sessions, inpatient days, co-payments,
deductibles and maximum out-of-pocket expenses that are
different from limits imposed on other care.
Family Opportunity Act Stalls
Congress again failed to enact legislation to expand Medicaid coverage to
include more children with severe emotional
disturbance, which would reduce families' need to relinquish
custody to access mental health service for their child. The
Family Opportunity Act (S. 622, H.R. 1811) is sponsored by
Senators Charles Grassley (R-IA) and Edward Kennedy (D-MA) and
Representatives Pete Sessions (R-TX) and Henry Waxman (D-CA).
The bill would allow families to "buy in" to Medicaid on a
sliding scale to cover a child who meets the SSI definition of
disability. A family with access to employer-sponsored health
care that contributes at least 50% of the premium must elect
this coverage and use these benefits first. The child's
Medicaid coverage would then supplement the private health
insurance policy.
The Family Opportunity Act also provides a needed fix toMedicaid's home- and
community-based waiver to allow children
with serious emotional disturbance who are at risk of being
placed in a residential treatment center or who are currently
receiving services in such a center to access services under
the waiver. (Only children in or at risk of placement in a
hospital are now eligible for services under the waiver.) This
provision is also included in the recently introduced Keeping
Families Together Act (S. 1704, H.R.
3243).
The Senate committee approved its version of the bill, but the
House failed to act this year. It will remain a priority for
the sponsors and for advocates next year.
Keeping Families Together
In October, Senators Susan Collins
(R-ME), Mark Pryor (D-AR), Norm Coleman (R-MN) and Jeff
Bingaman (D-NM) and Representatives Jim Ramstad (R-MN), Patrick
Kennedy (D-RI), Pete Stark (D-CA), Charlie Norwood (R-GA),
Spencer Bachus (R-AL), Charles Pickering (R-MS), Mike Castle
(R-DE) and Nancy Johnson (R-CT) introduced legislation to
address the custody-relinquishment problem. Enactment is a high
priority for mental health and child welfare advocates.
The Keeping Families Together Act (S.
1704 and H.R. 3243) would
promote comprehensive interagency systems of care for children
with mental or emotional disorders by providing six-year "
Family Support Grants" to help states build new state-level
infrastructure. It will also establish a new federal
interagency task force to examine mental health issues in the
child welfare and juvenile justice systems. The bill would
require states to report annually on the success of the
programs and activities and the Department of Health and Human
Services to provide a report to Congress evaluating states'
success in addressing custody relinquishment.
The legislation would authorize $4.5 million for FY 2004, $6.5
million for FY 2005, and $11 million for each fiscal year from
2006 to 2009. The federal task force would be authorized at $1
million for each fiscal year from 2004 to 2009.
IDEA Reauthorization Carries Into Next Year
Congress adjourned without completing reauthorization of the
Individuals with Disabilities Education Act (IDEA).
The Senate had been poised for floor debate, but the bill
slipped into next year. The Senate bill (S.
1248), while not as
protective of students' rights as current law in situations
involving discipline, is still much stronger than the
House-passed bill. It encourages the use of positive behavioral
supports to help students with behavior problems and would
require schools to determine whether the offending behavior was a manifestation
of the child's disability before suspending or expelling the child. This process
would investigate whether a
violation of the school's conduct code was the result of the
child's disability or the school's failure to implement the child's individualized
education plan (IEP) or to use
appropriate behavioral interventions.
In contrast, the House-passed version (H.R.
1350) would
dramatically alter the IDEA's current discipline standards,
allowing schools to expel children with disabilities at will if they violate
the "school's code of conduct." This bill would
seriously impair the ability of many students with disabilities
to succeed in school.
Advocates will continue to push for a final bill that protects
students with disabilities from inappropriate exclusion from
classroom or school. In the meantime, the Bazelon Center will
support continuation of current law.
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