House Measures Introduced that would Improve Services for Individuals with Serious Brain Disorders
On June 28, a bipartisan coalition of House members led by Marcy Kaptur (D-OH) and Jim Greenwood (R-PA) introduced two important pieces of legislation that would extend evidence-based treatment such as PACT under the Medicaid Program and would establish regional consumer-run support centers to assist States, HMOs and other entities involved in the development of peer-support activities. NAMI strongly supports both of these measures.
The Medicaid Intensive Community Mental Health Treatment Act of 2001, HR 2364, is a continuing effort by Representative Marcy Kaptur and a House bipartisan coalition to allow states to use Medicaid funds to invest in community-based programs serving adults with serious brain disorders. HR 2364 would provide states with the option of covering intensive community mental health treatment under the Medicaid program. States could offer a new set of consolidated, optional services under federal Medicaid law. The new intensive community treatment option would include key elements of the PACT model, including a recovery-oriented, 24-hour-a-day, seven-day-a-week, mobile, interdisciplinary team approach to treatment. Comprehensive services would include treatment for individuals with co-occurring mental illness and substance abuse disorders, medication education and management, and family education.
Currently, federal financing of community-based mental health care is spread across more than six optional Medicaid service categories. Patchwork state and county programs are marked by lack of coordination, inflexible funding streams, and missing service components. In contrast, the Kaptur-Greenwood proposal would permit states-through a single policy decision-to finance all necessary community-based services.
The Mental Illness Consumer-Run Services Support Act, HR 2363, is specifically designed to integrate the historical knowledge and experience of consumers in the development of peer-support programs that best meet the needs of persons with serious brain disorders. This Greenwood-Kaptur proposal would provide grants to establish 10 regional centers across the country that are consumer-run and intended to provide assistance in planning, providing and evaluating nonprofessional services to individuals with severe mental illnesses. The consumer-run centers authorized in this legislation would advise and assist State and local governments, HMOs, non-profit and other organizations on how to effectively invest in peer-run programs. HR 2363 also makes clear that consumer-run programs supported with federal funds are to operate as complementary to, not as a complete substitute for, psychiatric treatment.
HR 2363 authorizes $5 million for the development of the consumer-run regional centers for FY 2001, and extends authorized funding through FY 2005. As an authorization measure HR 2363 must first be passed and signed into law before Congress can allocate funding for these programs.
All NAMI members and advocates are encouraged to contact their members of the House of Representatives and urge them to cosponsor HR 2364 and provide states with this important option to offer evidence-based community treatment programs such as PACT that have a demonstrated record of effectiveness in serving people with severe mental illnesses.
All NAMI members and advocates are also urged to contact their member of Congress and urge cosponsorship of HR 2363 and voice support for high quality consumer-run services as a complement to mental illness treatment.
All members of Congress can be reached by calling the Capitol Switchboard at 202-224-3121 or by going to the policy page of the NAMI website at http://www.nami.org/policy.htm and click on "Write to Congress."
For more information on PACT (Program for Assertive Community Treatment) please go to the NAMI website at http://www.nami.org/about/pact.htm
What is PACT?
The Program of Assertive Community Treatment (PACT) is one of the most successful mental health service delivery models today. PACT is evidence-based and outreach-oriented. It utilizes a 24-hours-a day, 7-day-a-week, interdisciplinary, mobile team approach to treatment. It delivers comprehensive treatment, rehabilitation and support services in community settings. High quality PACT services typically are implemented at costs significantly less than those of putting individuals with severe mental illnesses in a hospital, residential treatment facility, or jail. PACT also is especially effective in serving individuals for whom previous, traditional treatment has been unsuccessful, including those with co-occurring substance abuse disorders and high use of inpatient care. Among the services typically integrated into PACT are 24-hour comprehensive care, psychiatric rehabilitation, integrated mental illness and substance abuse treatment, housing or housing supports, crisis intervention and peer counseling.
Federal funding of community-based mental health services is greatly diffused, spread across numerous mandatory and discretionary programs. Within Medicaid, community-based mental health services run through more than six separate optional service categories. Moreover, the complicated federal scheme relies on numerous state and local funding streams. The inevitable result is a complex, confusing patchwork of programs, with fragmented services at the community level. Wide disparities also exist among the states in Medicaid spending on mental health services: New York, Massachusetts, and Wisconsin are at the high end; Illinois, West Virginia and Texas are at the low end.
In 1995 and 1997, efforts were made to amend Medicaid to allow assertive community treatment as a state option. In 1997, the effort failed as a result of preliminary estimates by the Congressional Budget Office (CBO) to "score" the option as a mandatory program, involving significant costs. The estimate was based in part on assumptions that states would use the option to draw additional federal Medicaid dollars.
In fact, many PACT services already are available to states as optional Medicaid services. The new option need not incur federal obligations. The Medicaid Intensive Community Health Treatment Act will permit states to finance consolidated, community-based services. It also represents a cost-effective state-level response to problems associated with deinstitutionalization, homelessness, and the costly trend toward criminalization of mental illness.