House Passes Managed Care Patient Bill Of Rights; Senate Adds Additional Funds For The Mental Health Block Grant ACTION REQUESTED

Sponsored by Representatives Charlie Norwood (R-GA) and John Dingell (D-MI), the bill establishes an entire new system of federal standards for all managed care plans, including a number of protections critically important to people with severe mental illnesses and their families. Among these are curbs on the use of restrictive prescription drug formularies and new external appeals for unjustified denial of treatment. HR 2723 would also grant plan enrollees new rights to seek providers outside of an HMO's network, allow a limited right to continue with a provider when switching plans, and require plans to pay for more emergency treatment. The most controversial piece of the bill would allow patients to sue their health plan for damages in state court over a wrongful denial of care. A provision strongly opposed by business and insurance interests.

Despite this victory for Patient Bill of Rights advocates, the future of Norwood-Dingell bill is in doubt. First, HR 2723 was joined with a separate bill to expand access to health coverage for the uninsured. This bill, HR 2990, is strongly opposed by the President and would likely provoke a veto if sent to the White House in its current form. In addition, Norwood-Dingell must also be reconciled with the more modest Senate bill (S 1344) that does not include the right to sue plans in state court and does not extend patient protections in enrollees in fully insured plans. It may be several weeks before a House-Senate Conference Committee is convened to work through the many difficult and controversial differences between the two bills.

House Rejects More Limited Alternatives to Norwood-Dingell

Before the House passed HR 2723, members defeated two alternative patient protection bills including a measure sponsored by Representatives Tom Coburn (R-OK) and John Shadegg (R- AZ) that included a limited right to sue health plans in federal court (193-238) and a measure sponsored by Representative John Boehner (R-OH) that had no right to sue (145-284). Beyond the differences over the right to sue, both the Coburn-Shadegg and Boehner alternatives contained more limited protections in areas such as prescription drug formularies, external appeals, access to clinical trials and choice of plans.

For more information on provisions in the Norwood-Dingell bill and NAMI's position on Patient Bill of Rights legislation, click on:
http://www.nami.org/update/990930.html or
http://www.house.gov/norwood/summary080699.html or
http://www.nami.org/update/unitedbill.html.

House-Passed "Access" Bill Raises Concerns for NAMI

As mentioned above, the House Republican leadership added a separate bill (HR 2990) intended to expand health coverage for the 44.3 million Americans who lack access to insurance. The bill passed on October 6 by a 227-205 vote. It includes a range of measures including expanded tax deductions and tax credits for people who currently lack coverage, medical savings accounts (MSAs), association health plans (AHPs), multi-employer purchasing cooperatives (known as MEWAs) and Health Marts. The White House is opposed to each of these measures and has threatened to veto any patient protection bill that includes them. In addition, the White House has concerns regarding the bill's cost, estimated at $48.6 billion over 10 years, financed through future anticipated federal budget surpluses. The White House also points to a congressional Joint Economic Committee study showing that the tax provisions would benefit only 1% of those who are now uninsured.

While NAMI strongly supports the goal of HR 2990 to expand access to coverage for the uninsured, the organization opposes the AHP, MEWA and HealthMart proposals as a direct threat to state mental illness parity and mental illness coverage laws. These measures would allow vast numbers of small employers to band together to offer self-insured health plans under ERISA - the federal law that allows employers to self insure and exempt their plans from state law.

In recent years, the number of states that have enacted mental illness parity laws has expanded to 28 (California, the newest and largest state was added last week). In each of these states, these state parity laws do not cover individuals and families enrolled in ERISA self-insured policies. While the federal Mental Health Parity Act (MHPA) does apply to ERISA plans, its requirements (parity is limited to annual and lifetime dollar limits) are far below most of the existing state laws. Because of the potential impact that expansion of coverage through AHPs, MEWAs and HealthMarts could have on state parity laws, NAMI remains opposed to their being included in any final patient protection bill.

Senate Votes Additional Funds for the Mental Health Block Grant

While the House was working on patient protection legislation yesterday, the Senate was completing action on the FY 2000 Labor-HHS-Education Appropriations bill (the funding bill for all major federal human service programs). During debate on the bill (S 1650), Senator Paul Wellstone (D-MN) was successful in adding an additional $49 million for the Mental Health Block Grant program. This increase is on top of the $21 million boost that was already included in the Senate Labor-HHS Appropriations bill, bringing the total up to $359 million - the same amount as originally requested by President Clinton. Note - in a NAMI E-News message sent out on October 5, it was erroneously noted that the Wellstone amendment was to increase the Block Grant by $75 million; NAMI staff apologizes for this error.

NAMI advocates owe Senator Wellstone and those who played a critical role in passing his amendment - particularly Senators Arlen Specter (R-PA), Tom Harkin (D-IA), Pete Domenici (R-NM), Harry Reid (D-NV) and Ted Stevens (R-AK) - a tremendous thanks. The House version of the FY 2000 Labor-HHS-Education Appropriations bill (HR 3730) is expected to go to the floor next week. It contains only $300 million for the Mental Health Block Grant and $39.1 million less than the Senate level for the National Institute of Mental Health (NIMH is funded at $969.5 million in the Senate bill).

ACTION REQUESTED

NAMI advocates are urged to continue their efforts to press for additional funds for both NIMH and the Block Grant and to urge that Congress target additional Block Grant funds for FY 2000 to targeted populations such as adults and children with the most severe mental illnesses and evidence-based services such as PACT programs. Advocates should also contact the White House to remind the President that the Mental Health Block Grant was a priority in his FY 2000 budget and that his Administration should make the program a top priority in final budget negotiations with Congress. Remind the President that the increase he proposed for the Block grant was justified on the basis of the growing public health crisis associated with untreated mental illness. The White House can be reached by calling 202-456-1414 or through their website at http://www.whitehouse.gov/WH/Mail/html/Mail_President.html

The NAMI Family-to-Family Education Program is a free 12-week course for family caregivers of individuals with severe brain disorders (mental illnesses). The course is taught by trained family members. All instruction and course materials are free for class participants.