Congress Begins August Recess Leaving Key Mental Illness Issues Unresolved NAMI Advocates Urged To Request Meetings With Members Of Congress

Even through only a few weeks remain in the 106th Congress, members still have a large number of issues facing them on their return to Washington in September. In addition to annual spending bills that Congress and the President must agree on before the new fiscal year begins on October 1, efforts will be made to resolve key issues including Medicare prescription drug coverage, Medicaid coverage for children with severe disabilities and a Patient Bill of Rights. In addition to these issues, NAMI will also be pushing for action on bills to promote access to integrated treatment for persons with co-occurring addictive disorders, address the growing trend of "criminalization" of mental illness and curb the inappropriate use of restraint and seclusion.

ACTION REQUESTED

Included below are action items and brief descriptions of each of the policy issues that NAMI advocates are urged to bring to the attention of their state's congressional delegation at meetings during the current summer recess. Links are included to additional background information that may be needed. Given the large number of mental illness issues now pending before Congress, NAMI advocates are urged to pick and choose a few priority items to raise in meetings with members of Congress. Phone numbers and addresses can be found in your local phone book, or by visiting the websites of individual members of Congress at: http://www.senate.gov/senators/index.cfm and http://www.house.gov/house/MemberWWW.html

1. Mental Illness Treatment Enhancement Legislation

On July 27, a bipartisan coalition of House members led by Representatives Ted Strickland (D-OH) and Heather Wilson (R-NM) introduced a House version of the Mental Health Early Intervention, Prevention and Treatment Enhancement Act (HR 5091). This legislation (S 2639), originally introduced by Senators Pete Domenici (R-NM) and Edward M. Kennedy (D-MA), includes a range of proposals designed to address gaps in publicly-funded mental illness treatment programs. NAMI strongly supports S 2639 and HR 5091, particularly its provisions addressing "criminalization" of mental illness, suicide prevention and integrated treatment. More information on S 2639 and HR 5091 is available at: http://www.nami.org/update/S2639.html and http://www.nami.org/pressroom/000727.html. NAMI urges all members of Congress to support and cosponsor S 2639 and HR 5091.

2. Family Opportunity Act

In an effort to address the difficult and painful choices that families of children with severe mental illnesses face in accessing needed treatment, NAMI is strongly supporting the Family Opportunity Act (S 2744 and HR 4825). This legislation would allow states to set up Medicaid buy-in programs for children with severe disabilities so that parents would not be forced to relinquish custody of their children or declare bankruptcy in order to get coverage for the treatment their child needs. More information on S 2744 and HR 4825 can be found at: http://www.nami.org/update/S2274.html and http://www.nami.org/update/000713.html. NAMI urges all members of Congress to support and cosponsor the Family Opportunity Act (S 2744 and HR 4825) and ensure its passage this year.

3. Parity

Addressing the issue of insurance discrimination has always been a high priority for NAMI. NAMI is strongly supporting legislation (S 796) to expand the 1996 Mental Health Parity Act to full parity - barring health plans from imposing limits on coverage for treatment of severe mental illness that do not apply to all other diseases. More information on S 796 can be found at: http://www.nami.org/update/S796.html. NAMI urges all members of Congress to support and cosponsor S 796, and protect the 33 state parity laws by opposing expansion of Association Health Plans (AHPs) as part of the Patient Bill of Rights.

4. FY 2001 Funding for Research and Services

With only a few weeks remaining before the beginning of the new fiscal year on October 1, Congress must complete action on the FY 2001 Labor-HHS-Education Appropriations bill (HR 4577). While House and Senate conferees have made progress in resolving differences between their separate bills, the legislation is still far from acceptable to President Clinton. With record surpluses expected for next year, Congress and the President are already adding back billions to the Labor-HHS bill. More information on issues of concern to NAMI in HR 4577 can be found at http://www.nami.org/update/000710.html. NAMI urges members of Congress, especially members of the House-Senate Conference Committee, to include in the final FY 2001 Labor-HHS Appropriations bill:

• a full 15% increase for basic scientific and clinical research on severe mental illness at the National Institute of Mental Health (NIMH),
• increases for the Mental Health Block Grant and PATH (homeless people with mental illness) programs, with specific targeting of increased funds for evidence-based programs such as PACT,
• the Dodd Amendment to curb the inappropriate use of restraint and seclusion in psychiatric hospitals, and
• specific direction for the Center for Mental Health Services (CMHS) to fund a national demonstration program on jail diversion for persons with severe mental illnesses charged with non-violent offenses.

On July 17, a coalition of House Democrats introduced legislation (HR 4867) to reauthorize the Substance Abuse and Mental Health Services Administration (SAMHSA). Similar legislation (S 976) passed the Senate late last year. NAMI is urging that two specific provisions be included in any SAMHSA legislation. NAMI is disappointed that neither bill contains a NAMI supported initiative to foster replication of integrated treatment programs for persons with co-occurring addictive disorders. In addition, NAMI is supportive of provisions intended to reduce the use of inappropriate and unnecessary physical restraints and seclusion. More information on these issues can be found at: http://www.nami.org/update/000724.html. NAMI urges Congress to pass a SAMHSA bill that:

• permits states to blend Mental Health and Substance Abuse Block Grant funds to invest in integrated treatment programs for persons with co-occurring mental illness and addictive disorders free of onerous separate reporting requirements (neither S 976, nor HR 4867 contain this provision), and
• establishes new federal standards to prevent the inappropriate use of restraint and seclusion in psychiatric hospitals.

Even though only a few legislative days remain before the beginning of the new fiscal year, the Senate has yet to begin work on the VA-HUD Appropriations bill (HR 4635) - the bill that contains funding for all HUD programs. The House passed its version of HR 4635 on June 21. In addition to funding for HUD programs, Congress is also working on several housing authorization bills including homeless programs (HR 1073), elderly and disabled housing modernization (S 2733) and a new housing trust fund (S 2997). While the prospects for each of these bills passing Congress in the few legislative days remaining this year are slim, it is possible that major provisions in some of them could be added to the final VA-HUD bill. More information on these issues can be found at http://www.nami.org/update/000608.html and http://www.c-c-d.org/tf-housing.htm. NAMI urges Congress to:

• shift funding for renewal of expiring rent subsidies for the Shelter Plus Care and SHP permanent housing to the Housing Certificate Fund (Section 8) as part of the FY 2001 VA-HUD Appropriations bill,
• increase funding for the HUD Section 811 program to at least to the level requested by the President ($210 million) and limit tenant-based assistance to 25% of 811 funds,
• continue a set aside of Section 8 tenant-based rental assistance for non-elderly people with disabilities affected by "elderly only" designation of public and assisted housing, and
• increase funding for the McKinney homeless program to at least the $1.2 billion requested by the President.

On July 27, the Senate Judiciary Committee reported out legislation (S 1865) to authorize the Department of Justice to establish 25 Mental Health Courts to hear cases involving non-violent criminal charges brought against defendants with mental illness. The bill's sponsor, Senator Mike DeWine (R-OH), hopes to bring the bill to the full Senate by "unanimous consent" in September. A hearing on a companion House bill is expected in September as well. In addition, the mental illness treatment enhancement bill mentioned above (S 2639 and HR 5091) contains authorization for a mental health courts program, as well as jail diversion to treatment and training for law enforcement officers interacting with individuals with mental illness in the community. More information on these issues can be found at: http://www.nami.org/update/unitedcriminal.html. NAMI urges Congress to:

• cosponsor and support immediate passage of mental health courts legislation (S 1865 and HR 2594),
• cosponsor and support passage of mental illness treatment enhancement legislation (S 2639 and HR 5091), and
• include in the FY 2001 Labor-HHS Appropriations bill (HR 4577) a new jail diversion treatment program at the Center for Mental Health Services (CMHS).

8. Medicare Prescription Drugs

Despite the extreme popularity of expanding Medicare to include coverage for outpatient prescription drugs, Congress and the White House are still far from agreement on a single plan. The high profile of this issue in the coming political campaign may in fact be a barrier to any bipartisan agreement. While the House-passed bill (HR 4680) and the White House proposal agree on many key aspects, they differ on whether coverage should be extended as part of the basic Medicare program or through subsidies to purchase private insurance policies that offer such coverage. More information on this issue can be found at: http://www.nami.org/update/000623.html and http://www.nami.org/update/199912_stand.htm. NAMI urges Congress to make coverage of outpatient prescription drugs available to Medicare beneficiaries. NAMI urges that such coverage:

• be affordable to all Medicare beneficiaries including non-elderly people with disabilities who are on SSDI,
• not rely on plans that use restrictive drug formularies as a cost control mechanism with inadequate appeals process for individuals seeking off-formulary medications, and
• include "stop loss" coverage for individuals with especially high drug costs.

With few remaining legislative days before final adjournment, the prospects for passage of managed care Patient Bill of Rights legislation are slim. Even though bills have passed both the House and Senate (HR 2723 and S 1344), the White House and Republican leaders remain far apart on key issues including the right to sue health plans in state court and whether to extend protections to all insured Americans. Given the high political profile associated with patient protection legislation, leaders on both sides of the aisle may be content to take this issue to the voters in November. More information on this issue and NAMI's position can be found at: http://www.nami.org/update/000308.html. NAMI urges Congress to:

• enact a strong Patient Bill of Rights that covers all insured individuals and includes independent outside review of health plan coverage decisions, curbs on the use of restrictive prescription drug formularies and access to routine care associated with participation in clinical trials, and
• oppose efforts to expand Association Health Plans (AHPs) that are exempt from state mental illness parity and coverage laws.

For information on serious mental illnesses and brain disorders, or for a referral to your State and local affiliates, please contact the NAMI HelpLine: 1-800-950-NAMI (6264) / TDD 703-516-7227 Visit the HelpLine page