Congress Adjourns Until After The Election Leaving Family Opportunity Act And HHS Funding Bills Unresolved
Family Opportunity Act Still In Play
Also on the table when Congress returns will be a key NAMI priority, the bipartisan Family Opportunity Act (S 2274/HR 4825). While the outcome of this upcoming "lame duck" congressional session will be heavily impacted by the election results, there will be opportunities for the sponsors of the Family Opportunity Act (FOA) to add the bill to final budget and tax legislation. As NAMI advocates know, the FOA creates new state Medicaid "buy-in" options for children with severe disabilities, including severe mental illnesses, in order prevent families from having to go into poverty or relinquish custody in order get health care coverage for their children. NAMI strongly supports the FOA and urges advocates to continue the effort to persuade members of Congress to push for passage this year. For more information on the FOA, see NAMI E-News, Vol. 01-41 dated October 31, 2000, that is also in the process of being posted to the policy page of the NAMI website.
SUMMARY OF THE 2000 CONGRESSIONAL SESSION
Despite the current partisan impasse over the remaining FY 2001 appropriations bills and tax legislation, most of the bills of concern to NAMI have been resolved for the year. Included below is a summary of the final results on key legislative policy issues of concern to children and adults and with severe mental illnesses and their families. More details on each of these issues are available through the indicated links to the Policy page of the NAMI website.
FUNDING FOR RESEARCH AND SERVICES AT NIMH AND CMHS
As was noted above, one of the annual spending bills caught in the partisan divide between the White House and congressional leaders is the bill funding the Departments of Labor, Health and Human Services and Education for FY 2001. This bill (HR 4577) includes appropriations for key mental illness research and treatment programs including the National Institute of Mental Health (NIMH) and the Center for Mental Health Services (CMHS). Despite the fact that we are already a month into fiscal year 2001, both these agencies are still waiting for final word on their budget. However, it is important to note that the issues that divide the President and GOP leaders are unrelated to either NIMH or CMHS - they relate to school construction funds and OSHA regulations. As a result, it is already clear how various NIMH and CMHS programs will fare under the FY 2001 budget (although nothing is certain until Congress and the President reach a final agreement).
NIMH - Congress has again included significant increases for all NIH research institutes, including NIMH. For FY 2001, NIMH's budget is expected to top $1 billion for the first time ever - rising to $1.118 billion (a $143.3 million increase).
CMHS - For FY 2001, the Mental Health Block Grant is expected to receive a $64 million increase - up to $420 million. In fact, this final number is $4 million above the President's original request and amounts to a 31% increase over the past two years. The PATH program (services for homeless individuals with mental illness) is expected to receive a $6 million increase (up to $36.9 million). The Childrens Mental Health program is expected to get a $4 million boost in FY 2001 (up to $86.8 million) and the protection and advocacy (PAIMI) program a $1 million increase (up to $25.9 million). Finally, CMHS' discretionary program (known as "Knowledge Development and Application" or KDA) is also expected to receive a boost, up from $136.9 million to $145.7 million. However, it appears that the Administration's request for a new $30 million "targeted capacity expansion" program (that NAMI did not support) has been rejected by Congress.
Efforts to expand the limited 1996 federal parity law did not move forward in 2000. However, Senators Pete Domenici (R-NM) and Paul Wellstone (D-MN) continue to gain cosponsors and bipartisan support for their bill to expand federal law to full parity for severe mental illnesses (S 796). S 796 now has 28 bipartisan Senate cosponsors. Since Congress has not adjourned for the year, senators can still cosponsor S 796. NAMI advocates are encouraged to continue contacting their senators to urge them to cosponsor the bill (to view the current cosponsor list, go to the NAMI policy page http://www.nami.org/policy.htm and click on the link to S 796 in the Hot Issues section). Expansion of federal parity is expected to draw greater attention in 2001 as we move closer to the expiration date of the 1996 law on October 1, 2001.
RESTRAINT AND SECLUSION
This year Congress passed legislation intended to curb the inappropriate use of restraint and seclusion in psychiatric hospitals and residential treatment centers for children that accept federal funds. In addition, the new law establishes federal standards for reporting of deaths that occur while individuals are in restraints. These new standards are contained in the authorization law for the Substance Abuse and Mental Health Services Administration (SAMHSA) that was signed by President Clinton on October 17, P.L. 106-310 (additional details below). More information on the new restraint and seclusion law is available at: http://www.nami.org/update/000925.html
For the first time since 1992, Congress and the President agreed on legislation overhauling the activities of SAMHSA, including CMHS. NAMI is extremely pleased that this new law (P.L. 106-310) contains several of the key provisions from the mental illness treatment enhancement bill authored by Senators Pete Domenici (R-NM) and Edward M. Kennedy (D-MA) and Representatives Ted Strickland (D-OH) and Heather Wilson (R-NM), S 2639/HR 5091. Unfortunately, Congress refused to include an amendment NAMI pushed for that would have allowed states to blend mental health and substance abuse block grant funds to replicate integrated treatment programs to serve persons with co-occurring mental illness and addictive disorders. More details on the new SAMHSA authorization law are available at: http://www.nami.org/update/000928.html and http://www.nami.org/update/000926.html
On October 27 the President signed into law the FY 2001 VA-HUD Appropriations bill containing FY 2001 funding for HUD programs (P.L. 106-377). Included in HUD's FY 2001 are important increases for programs such as Section 811, Shelter Plus Care and Section 8 vouchers serving adults with severe mental illnesses. More details on the new HUD budget are available at: http://www.nami.org/update/001020.html
2000 saw major progress in focusing congressional attention on the disturbing trend of the "criminalization" of mental illness, i.e. the inappropriate placement of individuals with severe mental illnesses in jails and prisons and the role of lack of access to treatment in commission of non-violent offenses. A bill to create a new demonstration program at the Department of Justice creating mental health courts (S 1865) is now awaiting President Clinton expected signature. In addition, the SAMHSA authorization law (P.L. 106-310) includes a new jail diversion program at CMHS that will fund innovative local mental illness treatment programs targeted to individuals in the criminal justice system. In the case of both the new mental health courts and jail diversion programs, funding must be secured as part of the FY 2002 appropriations process next year. NAMI intends to place a high priority on seeking funds for these programs to ensure that they reach as many states and communities as possible. For more information on the provisions of the mental health courts legislation, S 1865, please go to http://www.nami.org/update/000802.html
MANAGED CARE PATIENT PROTECTIONS
Despite the fact that passage of a "Patient Bill of Rights" has been perhaps the most high profile issue in campaign 2000, congressional leaders and the White House were not able to agree on a bill. Given the political attention this issue continues to receive, it is almost certain that it will reemerge in 2001, regardless of the outcome of next week's election. Throughout most of 2000 attention focused on the bipartisan bill drafted by Representatives Charlie Norwood (R-GA) and John Dingell (D-MI), HR 2723. In 2001, NAMI will continue to push for protections that ensure access to mental illness treatment including curbs on restrictive prescription drug formularies, binding independent appeals of health plan decisions and routine care associated with clinical trials. More information on the competing House and Senate Patient Bill of Rights bills is available at: http://www.nami.org/update/unitedbill.html
MEDICARE PRESCRIPTION DRUGS
As with "Patient Bill of Rights" legislation, coverage of outpatient prescription drugs has been one of the most high profile issues in the 2000 election campaign. While the House passed a bill on June 28 (HR 4680), the Senate never took up this bill, or a competing White House plan. NAMI has not endorsed any specific proposal for expanding Medicare to include drug coverage. However, NAMI has offered support for several bills that meet several criteria of concern for Medicare beneficiaries with severe mental illnesses: eligibility for non-elderly disabled beneficiaries on the same terms and conditions as seniors, limits on the use of restrictive formularies for psychiatric medications, low-income beneficiary protections and limits on catastrophic costs. More information on Medicare prescription drug legislation is available at: http://www.nami.org/update/000623.html
Finally, the closing days of this year's session saw several proposals to bring parity to Medicare, including bills to require equal copayments for outpatient mental illness treatment services: HR 5434 introduced by Representative Marge Roukema (R-NJ) and S 3233 introduced by Senator Paul Wellstone (D-MN). In 2001 NAMI will again push for equitable coverage of both inpatient and outpatient treatment under Medicare.
STATE MEDICAID OPTION FOR PACT SERVICES
Legislation has also been introduced in these final days to support evidence-based treatment such as PACT under the Medicaid Program. Representatives Marcy Kaptur (D-OH) and Barbara Cubin (R-WY) introduced the Medicaid Intensive Community Health Treatment Act (HR 5572) that provides States with the option of coverage for intensive community treatment for people with serious brain disorders under Medicaid. Twenty-five years of research has demonstrated that PACT is more effective than office-based traditional care for people with the most disabling psychiatric illnesses. PACT reduces the most devastating outcomes of severe psychiatric disorders, including hospitalization, homelessness, and criminal incarceration. For more information on HR 5572 refer to NAMI E-News Vol. 01-40, dated October 27, 2000 that is also in the process of being posted to the policy page of the NAMI website.