[NYAPRS Enews] Bazelon DC Update: Medicaid Regs, ADA, Crminal Justice, Parity

[Harvey Rosenthal]

Bazelon Center Mental Health Policy Reporter

Volume VII, No. 5, July 8, 2008

Congress Reconvenes After July 4 Recess

Some Issues Bang, Some Need a Light

 

With several happily lopsided bipartisan votes, Congress gave advocates
for people with disabilities extra reasons to celebrate 2008's
Independence Day. The Senate followed an earlier House vote in approving
a nine-month moratorium on six Medicaid rules that would have restricted
access to needed mental health and school-based services. The House
overwhelmingly endorsed a compromise reaffirming protections for people
with disabilities under the Americans with Disabilities Act. House
members also gave solid support to a bill that would halt the neglect
and abuse of teens that has prevailed in many residential treatment
settings. And appropriators in both houses approved increased funding
for critical criminal justice and mental health programs. 

 

Harmful Medicaid Regulations Stopped

Advocates for people with mental disabilities across the country are
celebrating success. Efforts in response to Action Alerts like the
Bazelon Center's
<http://www.bazelon.org/takeaction/2008/3-20-08CMSrules.htm>  helped
convince Congress to delay implementation by the Centers for Medicare
and Medicaid of damaging rules on rehabilitative services, targeted case
management and school-based administration and transportation services. 

The supplemental war-funding bill (H.R. 2642, Supplemental
Appropriations Act), approved 96-6 by the Senate and signed by the
President on June 30th, includes a moratorium until April 1, 2009 for
these three cost-cutting regulations along with three others that
involve graduate medical education, a provider tax and public-provider
cost limits. A seventh regulation on outpatient services under Medicaid
was excluded from the moratorium. See the Bazelon Center's July 7th Aler
<http://www.bazelon.org/takeaction/2008/7-01-08CMSmoratorium.htm> t for
details. 

The rules on rehabilitative services and school-based administration and
transportation services were scheduled to take effect on June 30th. They
had been on hold under a moratorium enacted last year in the Medicare,
Medicaid and SCHIP extension Act (P.L. 110-173). 

The House voted 349-62 to approve the supplemental funding bill on April
23 with the same delay of the six Medicaid rules, after a successful
compromise with the White House. 

 

ADA Amendments Act Wins Amazing House Vote

By an extraordinary margin of 402-17, the House passed the ADA
Amendments Act to reverse Supreme Court holdings that had deprived many
people with disabilities of the law's vital protections. The bill would
restore the intent of Congress when it enacted the Americans with
Disabilities Act (ADA) in 1990.

Over the past decade, courts have supported employers in cases that
diminished the protections established by the ADA. In response, over the
past few years civil rights and disability advocates worked with
congressional staff to craft a bill, the ADA Restoration Act, that would
restore these protections.

A few months ago, the business community, apparently concerned about the
prospect of that law's enactment next year, signaled a willingness to
negotiate. The bill's House sponsors, Representatives Steny Hoyer (D-MD)
and James Sensenbrenner (R-WI) invited the advocates to work on a
compromise with the U.S. Chamber of Commerce and other representatives
of the employer community. The remarkable June 25th vote was the result
of several months of intense negotiations by this unique alliance.

The bill must still be considered in the Senate, where a version is
expected to be approved. If signed by the President-and no veto is
anticipated-it would:

*	specifically overturn Supreme Court decisions that have caused
many people with disabilities whom Congress intended the ADA to cover to
lose important protection; 
*	make it clear that Congress intended the ADA's coverage to be
broad, to cover anyone who faces unfair discrimination because of a
disability; 
*	clarify that the courts must apply a less demanding standard
than they have been using to determine who has a disability; 
*	make it easier for people with episodic impairments to be
protected by the ADA; 
*	afford broad coverage for individuals "regarded as" having a
disability under the ADA; and 
*	make it clear that accommodations need not be made for someone
who seeks coverage solely because he or she is "regarded as" having a
disability. 

In a nutshell, the proposal strikes a balance between protections for
individuals with disabilities and the obligations and requirements of
employers.

The Bazelon Center is particularly gratified that the ADA Amendments Act
will, when approved by the Senate, rescue people with psychiatric
disabilities from the "Catch 22" in which the court's rulings had left
them-that when medications reduce their symptoms, however temporarily,
many no longer qualify for protection as "disabled" under the ADA. 

For details, including the bill's text and a chart comparing the ADA
Restoration Act (which is before the Senate) and the amendments, see the
Bazelon Center's June 25th Alert
<http://www.bazelon.org/newsroom/2008/6-25-08ADAamendments.htm> . 

What You Can Do

Please visit http://clerk.house.gov/evs/2008/roll460.xml to see your
Representative's vote and say thank you by phone, postcard or email.

Call your Senators to express your support of the ADA Amendments Act of
2008. Urge him or her to vote for it when it comes before the Senate.  

(See www.bazelon.org/takeaction/How_to_Contact_Lawmakers.htm.)......  

 

Mental Health and Criminal Justice Funding

House and Senate Committees with jurisdiction over mental health funding
and criminal justice funding are moving forward on their fiscal year
2009 bills. 

Appropriations committees in both houses have approved funds for the
Department of Justice.  The mental health and criminal justice
collaboration grant (Mentally Ill Offender Treatment and Crime Reduction
Act), funded at $5 million in fiscal years 2006 and 2007 and $6.5
million in fiscal year 2008, was awarded $12 million by the Senate
committee and $10 million by the House committee.  

The grant program is designed to help states and localities address the
growing rate of incarceration of people with mental illness by providing
the flexibility to develop collaborative mental health and criminal
justice responses to offenders with mental illnesses. Grantees may seek
to create or expand programs that intervene at any point in the
continuum of criminal justice contact (pre-booking, post-booking, mental
health courts and other court-based approaches, re-entry and
transitional programs), including crisis-intervention teams and law
enforcement training.

The Senate appropriations committee has approved its bill funding
community-based mental health services administered through SAMHSA.  The
Senate committee bill would increase the PATH program by $6.4 million
and reject the $144-million cut proposed by the Administration to the
discretionary budget (which funds such programs as jail diversion,
seniors mental health services and suicide prevention), providing
instead a $12.5-million increase. Additionally, the protection and
advocacy system would be increased by $1 million, with funding for the
children's mental health services program and mental health block grant
at fiscal year 2008 levels ($102.3 million and $421 million
respectively). 

Although the House appropriations subcommittee approved its version on
June 19, the full committee's approval was stalled after a conflict
between Representative Jerry Lewis (R-CA) and Chairman David Obey (D-WI)
over the timing of a vote on an unrelated appropriations bill.

 

Newsbytes

*	JJDPA Reauthorization Bill Introduced in the Senate 

On June 18, Senate Judiciary Committee Chairman Patrick Leahy (D-VT) and
Senators Arlen Specter (R-PA) and Herb Kohl (D-WI) introduced
legislation to strengthen the Juvenile Justice and Delinquency
Prevention Act (JJDPA) to better aid in reducing crime and recidivism
within the juvenile justice system.  S. 3155, The Juvenile Justice and
Delinquency Prevention Reauthorization Act of 2008, would increase
federal funding for prevention, intervention and treatment programs,
including issues of mental health and substance abuse, and for the
improvement of state juvenile justice systems. The bill will likely be
considered by the Judiciary Committee in mid-July.

See Chairman Leahy's introductory statement
<http://www.bazelon.org/pdf/6-08JJpress.pdf>  and a summary of the bill
<http://www.bazelon.org/pdf/6-08JJsummary.pdf> .

*	Medicare Mental Health Parity Quest Continues 

The search for mental health parity in Medicare coverage continues. The
Medicare Improvements for Patients and Providers Act of 2008 (H.R.
6331), passed by the House by 355-59 on June 24th, was blocked from
consideration on the floor by Senate Republicans prior to the July 4th
recess. H.R. 6331 would make improvements to Medicare for low-income
seniors and those with disabilities who rely on the federal health
insurance program for necessary health care. Notably it would end the
discriminatory 50% co-insurance requirement for outpatient mental health
services (to be phased in over six years to establish parity with other
outpatient co-payments of 20%).

Both House and Senate bills would eliminate the 10% Medicare payment cut
for physicians (effective July 1) and substitute an increase. Continued
efforts by the Senate to pass a Medicare physician payment-fix bill this
year will likely include language to eliminate the payment cut
retroactively....  

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