| With crucial congressional
and presidential elections less than 10 months away, the
conventional wisdom in Washington is that not much legislating will
be done in the second session of the 106th Congress. Nonetheless, a
series of important mental health issues will be considered, and
NMHA holds out hope that several key legislative items can be passed
before the senators and representatives go home to campaign.
|
Mental
Health
Parity:
|
Although the outlook for both the House
(H.R.
1515) and Senate (S.
796) parity measures remains unclear, a series of related
legislative and administrative activities are scheduled. They
include:
- In April, the General Accounting Office (GAO) - which is the
accounting arm of Congress - will release a report on the
implementation of the Mental Health Parity Act (MHPA) of 1996. As
you'll recall, that law eliminated lifetime and annual dollar
limits applied against people with mental disorders in the private
health insurance marketplace. At this juncture, it appears that
the law has had a very small impact on the cost of health
insurance in the United States. In fact, according the U.S.
Department of Labor, only six (6) firms NATIONWIDE (!!) have
sought an exemption under the law because they experienced mental
health benefit increases of more than 1% in attempting to comply
with the MHPA.
- In May, the Senate Health, Education, Labor and Pension (HELP)
Committee - chaired by Sen. Jim Jeffords (R-VT.) - will hold a
public hearing to examine mental health parity issues. Chairman
Jeffords only agreed to the hearing after a concerted effort by
the Vermont Mental Health Association urging him to look at the
economic and social issues surrounding non-discriminatory mental
health insurance benefits. It's highly likely that both Sen. Pete
Domenici (R-NM) and Sen. Paul Wellstone (D-MINN.) will testify at
the hearing. NMHA is now weighing the possibility of U.S. Surgeon
General David Satcher testifying as well. The recent Surgeon General's Report on Mental Health flatly stated
that there was "no scientific justification" for the disparity
between mental and physical illnesses in private health insurance
policies (yet 90% of health plans discriminate against people with
mental disorders).
- Later in the spring, the Office of Personnel Management (OPM)
will issue its "call letter" detailing how mental health parity
will be implemented for federal workers. As you'll recollect, all
nine million Americans covered through the Federal Employee Health
Benefits Program (FEHBP) will have access to non-discriminatory
mental health benefits in 2001.
|
Federal
Mental
Health
Budget: |
NMHA is hoping that President Clinton
will include a response to the surgeon general's mental health
report in the FY 2001 budget that he submits to Congress in
February. While details are sketchy, early indications are that both
the Mental Health Block Grant and the Children's Mental Health
Services Program will both receive budget increases (of unknown
size). Moreover, we strongly believe that an opportunity exists to
improve Medicaid financing for community-based services in the
remaining year of the Clinton presidency. (see below) |
| SAMHSA: |
Legislation renewing the budget
authority for the Substance Abuse and Mental Health Services
Administration (SAMHSA) passed the Senate last fall. The bill is now
pending before the House Commerce Committee. Although the measure
(S.
976) meets many of our policy objectives, it's disappointing in
at least two respects. First, the bill contains inadequate
provisions addressing the needs of individuals with co-occurring
mental illnesses and addiction disorders. Specifically, the SAMHSA
measure lacks language permitting states to blend mental health and
substance abuse dollars in order to finance integrated treatment
programs for the so-called "dually diagnosed." The availability of
such programs is critically important to helping the homeless
mentally ill and avoiding the re-institutionalization of persons
with mental illnesses in state and county prisons. Second, S. 976
does not provide the 59 State Mental Health Planning Councils with
sufficient statutory authority to engage in long-term planning. NMHA
will be working to persuade the House on both of these critical
issues |
Seclusion
&
Restraint: |
NMHA and its allies in the mental
health community will be looking for opportunities to pass either
the Senate or House "Freedom From Restraints" Act. (S.
736/H.R.
1313). Senator Joe Lieberman (D-CT.) and Representatives Pete
Stark (D-CA.) and Rep. Diana DeGette (D-CO.) have re-affirmed their
commitment to passing a bill establishing permanent minimum federal
standards for the use of restraints in psychiatric hospitals and
residential treatment centers. Of all the issues that NMHA staff
works on, this may well be the most important because it involves
saving the lives of persons with mental illnesses. |
|
What Bills Involve Higher Odds?
|
HMO
Patients
Bill
of
Rights: |
It now appears that the House
Republican leadership is ready to proceed with a bill that protects
the rights of consumers enrolled in HMOs and other managed care
plans. However, there are at least two hurdles to a White House
signing ceremony. First, the House and Senate bills vary widely. For
example, the House version permits consumers to sue HMOs in state
courts, but the Senate bill doesn't. Second, assuming these
differences can be resolved, the House may insist upon certain
provisions that are deal breakers for NMHA. Specifically, the House
measure contains language creating so-called "Association Health
Plans " (AHPs) that would permit employers to exempt themselves from
the 27 mental health parity that states have passed since 1991. If
the AHP concept is included in the final version of proposed patient
rights legislation, NMHA would urge President Clinton to veto the
bill. |
Intensive
Community
Mental
Health
Treatment
Act: |
NMHA staff is still working to find
congressional sponsors for this important legislation. In brief, the
bill gives states the option to finance the entire array of
community-based services needed by children and adults with serious
mental disorders who wish to live in the community. We strongly
believe that bill simplifies the decision-making process of state
governments, fills in (often huge) gaps in the community-based
service network and improves coordination among existing service
providers. |
