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House Passes Patients Bill Of
Rights Overwhelmingly & Senate Approves $70 Million For Mental Health
Block
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"It was quite a day for the mental health field," says
Faenza |
House Passes
Very
Good
Managed Care Bill: |
In a stunning vote, the House of
Representatives passed the Norwood/Dingell Managed Care Patients
Bill of Rights Act (H.R. 2723). The bill passed despite the
determined opposition of both the House Republican leadership as
well as the business community and the entire insurance industry.
Since 170 Americans get their mental health insurance coverage
through various managed care arrangements, our community has an
enormous stake in the outcome of this legislative battle. H.R. 2723
will now advance to a conference committee with the Senate were its
fate will be decided. The Senate managed care measure is vastly
inferior to Norwood/Dingell. Please note, however, that while the
passage of H.R. 2723 represents a major breakthrough, there was
troubling news emerging from the House vote as well. Here's the
breakdown. |
Why
is
Norwood/Dingell
So Good? |
- Access To "Off Formulary Medications" -- H.R. 2723
requires all health plans to allow doctors and consumers to access
psychotropic medications not listed on the HMO drug formulary when
medically necessary.
- External Review -- Norwood/Dingell permits consumers to
insist that an independent panel of medical experts review
decisions denying benefit claims. Health plans could be penalized
up to $1,000 a day for failure to comply with the reviewers'
decision
- Right To Sue -- The Patients Bill of Rights grants
consumers the right to sue HMOs in state courts when the delay or
denial of care results in serious harm. Perhaps just as important,
efforts by Rep. Tom Coburn (R-OK.), Rep. John Shadegg (R-AZ.) and
Rep. Amo Houghton (R-NY) to explicitly prohibit children and
adults with mental disorders from going to court to seek damages
against the managed care industry were defeated by wide margins.
- Access to Specialists - Under Norwood/Dingell, health
plans must provide consumers prompt access to medical specialists
who need care.
- Emergency Room Care -- The Patients Bill Of Rights
guarantees access to emergency psychiatric services for consumers
in crisis.
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What's The
Bad
News? |
Under the auspices of improved access
to health coverage for 44 million uninsured Americans, the House
approved a new initiative - called Association Health Plans (AHPs)
-- that permits small and medium-sized companies to form
cooperatives for the purpose of purchasing health insurance coverage
for their workers. But employers participating in these new
associations would be exempt from ALL state mandated benefit laws -
including ALL 27 mental health parity laws now on the books.
NMHA will keep you informed about the progress of the conference
committee. The House and Senate won't finish ironing out the
differences between their respective bills until next year.
President Clinton has vowed to veto any patient protection
legislation that contains the AHP provisions, or other objectionable
access language. |
Biggest
Mental
Health Block
Grant Increase
In 20 Years |
On the same day that Norwood/Dingell
passed the House, Sen. Paul Wellstone (D-MINN.) successfully added
$50 million to the Mental Health Block Grant, bringing total
appropriation for that program to $353 million - the highest funding
total since it was first proposed by President Reagan in 1981. The
block grant finances community-based services for adults with severe
and persistent mental illnesses and children with serious mental and
emotional disturbances in all 50 states.
Earlier this year, the Clinton Administration (at the behest of
Mrs. Tipper Gore) proposed a $70 million increase for the Mental
Health Block Grant. Because of tight budget constraints, the Senate
Appropriations Committee provided only a $21 million increase for
the program. Therefore, at $304 million, the Senate's proposal was
about $50 million short of the president's objective.
Against strong opposition, Sen. Wellstone insisted that the
Senate fully finance the president's request. Sen. Harry Reid
(D-NV.) hurried to the floor to help to his colleague and lead a
discussion about the relationship between untreated clinical
depression and suicide. Ultimately, after a short debate, the Senate
agreed to the Wellstone amendment. If the House concurs with the
Senate in the final budget deliberations, the proposal will help
states extend community-based services to the people who need it
most. |
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