Congress Begins August Recess
NAMI Advocates Urged To Meet With Members Of Congress During Month-Long Recess
Congress has now begun its month-long summer recess, after struggling but failing, to complete action on range of policy issues of concern to NAMI’s consumer and family membership. Throughout the summer, Congress has been unable to act on many of these issues (funding for mental illness research and services, housing and managed care reform) because of partisan fights over tax and budget priorities and tight constraints on discretionary spending. As is being widely reported in the press, the ongoing dispute over the $792 billion Republican tax cut plan (and the expected presidential veto) remains the biggest divide between the White House and Congress. However, on a number of issues of importance to NAMI, the parties are either in agreement, or very close to forging workable compromises.
The August recess, which runs through September 8, affords NAMI advocates an important opportunity to meet directly with members of Congress to discuss issues of importance to people with severe mental illnesses and their families. Members of Congress are expected to be in their state/district offices throughout the month and most are available to meet with groups of constituents.
In addition, nearly all House members and Senators will also be holding "town meetings," visiting local radio call-in shows and making public appearances. These afford advocates a tremendous opportunity to speak directly to members of Congress and urge them to support NAMI’s legislative agenda.
Included below are brief summaries of the key policy issues NAMI is now working on and a few brief "Action Items for Congress" advocates can use when meeting with members of their congressional delegation.
1. FY 2000 MENTAL ILLNESS RESEARCH AND SERVICES FUNDING
Action on FY 2000 funding for NIMH (research) and SAMHSA (services) has been stalled as result of the strict caps placed on discretionary spending under the 1997 Balanced Budget Act. Funding for both NIMH and SAMHSA is part of the Labor-HHS-Education Appropriations bill, the largest domestic spending bill and the last of the 13 appropriations bills to be acted on. Because of its relative size, it has thus far been used to make up shortfalls in the other 12 bills, leaving its overall allocation of $15.8 billion below current levels. If nothing is done to either lift the current spending caps, or find some other source of offsetting cuts or revenues, appropriators will be forced to make deep cuts in all programs under the bill, including NIMH and SAMHSA. These cuts would occur, despite the prediction of looming federal budget surpluses and congressional efforts to double the NIH and NIMH budgets over the next 5 years and a Clinton Administration proposal to increase the Mental Health Block Grant by $70 million. Finally, NAMI is also focusing on efforts to enhance clinical research at NIMH focused on childhood violence and suicide (S 1555) and better target and blend SAMHSA block grant dollars toward integrated treatment for people with co-occurring mental illness and substance abuse.
NAMI urges Congress to:
- Adjust the current budget caps for FY 2000 in order to increase the NIMH budget by at least 10% and enact the Administration’s $70 million Mental Health Block Grant increase (with specific targeting of new funds for local PACT program development).
- Pass S 1555, the new Domenici-Kennedy child-adolescent violence/suicide research bill (all Senators should be urged to cosponsor HR 1555).
- Support a SAMHSA reauthorization bill that includes language allowing states to blend mental health substance abuse block grant funds to promote integrated treatment for people with co-occurring disorders (the current SAMHSA reauthorization bill, S 976 excludes this proposal).
In April, Senators Pete Domenici (R-NM) and Paul Wellstone (D-MN) introduced legislation to expand the 1996 Mental Health Parity Act toward full parity for a defined list of the most severe mental illnesses, and partial parity (treatment limits only) for all mental health disorders. Their bill (S 796) now has 20 cosponsors. In addition, in June, as part of the White House Mental Health Conference, President Clinton announced that the Federal Employees Health Benefits Program (FEHBP) would implement mental health parity beginning in 2001.
NAMI urges Congress to:
- Pass S 796 – the Mental Health Equitable Treatment Act of 1999 – and bring an end to discrimination in health insurance against people with severe mental illness and their families (Senators can support S 796 by cosponsoring the bill with Senator Domenici).
3. SOCIAL SECURITY WORK INCENTIVES REFORM
Congress is now closer than ever to addressing the issue of work disincentives in the SSI and SSDI programs. The Work Incentives Improvement Act of 1999 (S 331/HR 1180/HR 1091) cleared the Senate by a 99-0 vote on June 16 and the House Commerce Committee on May 19. It is now pending before the House Ways and Means Committee. The bill is intended to remove many of the barriers that currently exist in Social Security’s disability programs and corresponding health entitlements that prevent adults with disabilities from going to work. It would a) extend Medicare coverage for working SSDI beneficiaries, b) allow states the option of opening up the Medicaid programs to working people with disabilities, c) establish a new "ticket to independence" program to promote consumer choice in employment and rehabilitation services and increase access to long-term job supports, d) provide new protections against work-triggered CDRs, and e) allow for expedited re-entry to cash benefits when work attempts fail.
NAMI urges Congress to:
- Pass the Work Incentives Improvement Act immediately after the summer recess ends and allow consumers to go to work – government programs should never force people with severe mental illness to choose between a job and health coverage, or to go into (and stay in) poverty to get the health care coverage they need.
As in the case of funding for mental illness research and services programs, housing funding for FY 2000 (which begins on October 1, 1999) is caught in the grips of the tight caps on discretionary spending. On July 31, the House Appropriations Committee passed the FY 2000 VA-HUD Appropriations bill (HR 2684). The bill includes deep cuts for many HUD programs. However, through the leadership of Reps. Rodney Frelinghuysen (R-NJ) and James Walsh (R-NY), funding for housing programs serving people with disabilities, including adults with severe mental illnesses, were spared deep reductions. In particular, HR 2684 freezes HUD Section 811 at $194 million and allocates an additional $25 million for tenant-based rental assistance for people with disabilities displaced by designation of public and assisted housing as "elderly only." Separate authorization bills for homeless programs (HR 1073) and Section 811 (HR 202) are moving in the House.
NAMI urges Congress to:
- Adjust the current discretionary spending caps in order to increase funding for housing programs that serve low-income adults with severe mental illnesses (including Section 811 and targeted Section 8 rental assistance).
- Support renewal of all expiring homeless Shelter Plus Care rent subsidies and the 30% permanent housing set aside and 25% match in the homeless reauthorization bill (HR 1073).
5. MANAGED CARE PATIENT BILL OF RIGHTS
On July 15, the Senate passed a GOP managed care Patient Bill of Rights bill (S 1344) by a 53-47 margin. President Clinton has pledged to veto S 1344 as inadequate. The Administration’s main objections to the Senate bill are the absence of provisions: a) allowing consumers to sue health plans, b) applying standards in the bill to all health plans (not just employer sponsored self-insured ERISA plans), and c) giving doctors and patients the final say over determining "medical necessity." The House is expected to take up the managed care issue in September. A new plan developed by Rep. Charles Norwood (R-GA) and John Dingell (D-MI), that includes provisions on plan liability, is being opposed by GOP leaders on the basis of concern over increased costs to employers and the impact on the number of uninsured.
NAMI urges Congress to:
- Support a Patients' Bill of Rights that it is responsive to the needs of people with severe mental illnesses and their families by providing increased access to the newest and most effective treatments for serious brain disorders through binding federal standards on health plans.
- Ensure access to "off-formulary" medications (i.e., drugs not on a plan’s list) by barring health plans from charging unfair co-payments and deductibles on prescriptions for "off-formulary" medications and prohibiting health plans from denying access to FDA-approved drugs on the basis of the medication being "investigational" or "experimental."
- Support strong internal and external grievance procedures by requiring that decisions of independent review panels be legally binding upon health plans and prevent health plans from being able to select the independent third-party review panel.
- Ensure access to specialists by requiring health plans to provide access to covered specialty care within the network and offer "standing referral" provision (allowing unobstructed access to a specialist over a longer period, without authorization from a plan.
- Oppose AHP/MEWA and "Health Mart" proposals that vastly expand the use of multi-employer purchasing cooperatives to expand coverage for the uninsured through extension of ERISA (the federal law that allows employers to self insure and exempt their plans from state regulation) in a way that undermines the 27 state mental illness parity laws.
6. CURBING THE USE OF RESTRAINTS AND SECLUSION
As NAMI reported in NAMI E-News, Vol. 00-18, August 2, 1999, legislation recently voted favorably out of the Senate HELP (Health, Education, Labor, and Pensions) Committee reauthorizing the Substance Abuse and Mental Health Services Administration (SAMHSA) includes a modified version of Senator Christopher Dodd’s (D-CT) legislation (S. 750) to regulate the use of restraints and seclusion in federally financed health care treatment facilities. Acceptance of the Dodd bill by the Senate HELP Committee is a significant step forward and would help reduce the inappropriate use of restraint. However, the legislation does not include all of the NAMI endorsed public policy objectives.
NAMI has worked diligently with lawmakers and allies in the mental health community to develop legislation that sets national standards that restrict the use of seclusion and restraints to emergency situations in which physical safety is at risk and requires the mandatory reporting of deaths and injuries to state-based legal authorities. Senator Joseph Lieberman (D-CT) has also introduced legislation in the Senate (S. 736), and Representatives Diana DeGette (D-CO), Rosa DeLauro (D-CT) and Pete Stark (D-CA) introduced "The Patient Freedom from Restraint Act" (H.R. 1313) in the House. NAMI members should urge members of Congress to sign on as cosponsors of these bills and to ensure that the following provisions are included in any restraint legislation passed by Congress.
NAMI urges Congress to:
- Support SAMHSA reauthorization legislation (S 976) that includes Senator Christopher Dodd’s (D-CT) legislation (S. 750). Cospsonsor S 736 in the Senate and H.R. 1313 in the House.
- Ensure that the use of involuntary mechanical or human restraints or involuntary seclusion is only justified as an emergency safety measure in response to imminent danger to one's self or others.
- Require that restraints shall be used only with a physician's order. In emergency situations, a RN may initiate the use of restraints for the protection of the patient and/or others. shall be contacted and a verbal order must be obtained. The physician on duty/on-call must see the patient within thirty(30) minutes of the initiation of the restraints and document his/her assessment of the patient in the medical record.
- Require mandatory reporting of deaths and serious injuries to a legal authority in each state.