[NYAPRS Enews] Bazelon Update: Healthcare Reform Grassroots Effort Needed!

[Harvey Rosenthal]

Bazelon Center Mental Health Policy Reporter


Volume VIII, No. 5, July 9, 2009


Healthcare Reform Tops Congressional Agenda


Grassroots Action Needs to Intensify


Two big stories dominated national news this week: healthcare reform and
the nomination of Judge Sonia Sotomayor to the U.S. Supreme Court. Here
you'll find details on both, plus updates on other important
congressional actions. In the realm of criminal justice, these include a
difference between House and Senate allocations of funding for state
collaborations to reduce incarceration and a bill to ease the transition
to community living for offenders upon release from jail or prison,
particularly if they have mental illnesses. Another new bill would help
to keep youth with mental health conditions from falling through the
cracks as they transition into adulthood. Some good news comes, to no
one's surprise, in initiatives by both Congress and the Department of
Health and Human Services to restore and clarify important Medicaid
services needed by children and adults with mental disabilities. 


Healthcare Reform is at a Critical Stage 


Five committees in the two chambers of Congress are fully engaged in
work to enact comprehensive healthcare reform legislation this year. The
Senate Health, Education, Labor and Pensions (HELP) Committee is
continuing review of its "Affordable Health Choices Act" and the Senate
Finance Committee will soon release its proposal, as Chairman Max Baucus
(D-MT) works to release a bipartisan bill. The House has held several
hearings on its Tri-Committee (Energy and Commerce, Education and Labor,
and Ways and Means) proposal in preparation for markup of a bill,
expected next week. See the Bazelon Center's updated summaries
<http://www.bazelon.org/issues/healthreform/index.htm>  of these bills.

Enacting strong, comprehensive healthcare legislation this year will
require ample and intense grassroots action. It is essential for members
of Congress to hear from you about the importance of extending
affordable, quality health coverage to millions of Americans - without
delay. 


What You Can Do


Contact your Senators and Representative
<http://www.bazelon.org/takeaction/How_to_Contact_Lawmakers.htm>  now
and urge them to enact strong, comprehensive healthcare reform
legislation this summer. Remind them that mental illness is the leading
cause of disability in the United States for people between the ages of
15 and 44, and that mental health is part of health and must be
addressed in an integrated manner. 

With respect to integration of mental health into health systems,
healthcare reform should:

*	Provide access to health and mental health care coverage for
all. All Americans should qualify for healthcare services they can
afford, including mental health care. Mental health services must be a
part of any health plan's benefit and provided at parity with other
healthcare. Individuals with severe mental illnesses must have access to
the range of rehabilitation services that enable them to function
better.
*	Integrate mental health into primary care settings for both
children and adults. Co-location of primary care and specialty
behavioral health practitioners or collaborative care should be
encouraged. Primary care mental health services should also be
adequately reimbursed. Incentives must be provided to expand medical
homes and similarly organized systems of care that include behavioral
health specialists. Public mental health agencies should be eligible to
become medical homes to address the complex needs of individuals with
severe mental illnesses.
*	Expand early intervention and encourage evidence-based
prevention activities that include mental health. Incentives must be
adopted to ensure that proven prevention and early intervention services
are provided, particularly for very young children. Quality of care is
improved through the expansion of evidence-based practices.
*	Include attention to mental health disorders in programs of
chronic-care management. Mental health services should be integrated
into all chronic-care programs, such as those for diabetes, asthma,
heart disease and cancer, in order to treat co-occurring mental
disorders.
*	Include access to long-term services and supports, with
individuals who have psychiatric disabilities able to benefit. 

A letter by Representative Mary Bono-Mack
<http://www.bazelon.org/pdf/7-7-09BonoMackLetter.pdf>  (R-CA), as
vice-chair of the Congressional Addiction Treatment and Recovery Caucus,
to House Energy and Commerce Chairman Henry Waxman (D-CA) and Health
Subcommittee Chairman Frank Pallone (D-NJ) urges inclusion of mental
health and substance use services in health reform legislation.

See How to Contact Your Lawmakers
<http://www.bazelon.org/takeaction/How_to_Contact_Lawmakers.htm> . 

 


Mentally Ill Offender Act Funding Increase at Issue


The House would increase funding for the Mentally Ill Offender Act by $2
million over fiscal year 2009 (H. Rept 111-149) while the Senate
Appropriations Committee has proposed level funding at $10 million for
fiscal year 2010. The program provides grants to help states and
localities address the growing rate of incarceration of people with
mental illnesses by developing collaborative mental health and criminal
justice responses to such offenders. Grants are flexible, allowing
grantees 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 funding crisis intervention teams and
providing law enforcement training.  

The Senate has yet to act on the appropriations bill with jurisdiction
over the program. Ultimately a conference between the House and Senate
will determine final funding levels. Members of both houses signed a
letter to the Appropriations Committee chair
<http://www.bazelon.org/pdf/FY10MIOTCRA_letter.pdf>  expressing support
for increased funding.

 


Help for Transition-Age Youth with Mental Health Conditions


Legislation to keep youth with mental health conditions from falling
through the cracks as they transition into adulthood has been
reintroduced by Representatives Pete Stark (D-CA), Mary Bono-Mack (R-CA)
and Dave Camp (R-MI). The Healthy Transitions Act of 2009 (H.R. 2691)
would establish grants to help states develop and execute coordinated
plans to give adolescents and young adults with a serious mental health
disorders the tools they need to make a healthy transition to adulthood.
The bill would also establish a committee of federal partners to
coordinate the multitude of federal programs that assist adolescents and
young adults with mental illnesses (see the Bazelon Center's fact
sheets, Moving On
<http://www.bazelon.org/publications/movingon/index.htm> ). The
committee would also provide technical assistance to states and report
back to Congress.

The legislation is supported by the Mental Health Liaison Group (see
letter <http://www.mhlg.org/05-22-09.pdf> ). It addresses findings by
the Government  Accountability Office
<http://www.gao.gov/new.items/d08678.pdf>  that 2.4 million young adults
had a serious mental illness in 2006 and encountered difficulty finding
services to help them during transition to adulthood. The bill has been
referred to the House Energy and Commerce Committee.  For further
information please visit:  

For the bill text, please visit:
http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.2691:

For Rep. Stark's floor statement introducing the bill, please visit: 
http://www.stark.house.gov/index.php?option=com_content&task=view&id=128
7&Itemid=84
<http://63.97.74.131/exchweb/bin/redir.asp?URL=http://www.stark.house.go
v/index.php?option=com_content%26task=view%26id=1287%26Itemid=84> 


What You Can Do


Contact your Representative and urge him or her to co-sponsor H.R. 2691.
Adapt language from the MHLG letter <http://www.mhlg.org/05-22-09.pdf>
if you wish. You can find a current list of Representatives who are
supporting the legislation at http://thomas.loc.gov (enter the bill
number in the search box). 

 


Recidivism Reduction Act Introduced


Representatives Andre Carson (D-IN), Patrick Kennedy (D-RI) and Pete
Stark (D-CA) have introduced the Recidivism Reduction Act (H.R. 2829).
The legislation would provide timely restoration of federal disability
benefits (SSI, SSDI and Medicaid) to eligible individuals upon release
from incarceration. Its goal is to ease offenders' transition back into
society, especially for those who have mentally illnesses. Prompt access
to disability and medical benefits upon release is essential for access
to needed treatment, housing and other critical services and support
that can help avoid the cycle of recidivism. 

Currently, due to barriers in federal law, it takes considerable time-up
to several months- to reinstate benefits. H.R. 2829 would address this
delay and help foster successful transitions into the community by:

*	Providing provisional benefits on the day of release from prison
for eligible individuals whose benefits were suspended. The Social
Security Administration (SSA) would then check non-disability factors.
Should the person prove ineligible, benefits would be stopped. 
*	Providing provisional benefits for eligible individuals being
released from jail or prison if benefits have been terminated for no
more than 36 months. 
*	Increasing the federal match for states to update their computer
systems so that they can suspend, rather than terminate, Medicaid
benefits for inmates. The bill also provides for immediate reinstatement
of Medicaid upon release for individuals who were enrolled prior to
incarceration.  
*	Allowing for up to three case management services to be provided
to incarcerated individuals in order to engage in planning for services
following release. 
*	Providing for a pre-release program for SSDI recipients
identical to that now in place for SSI.

(See Rep. Carson's press release
<http://carson.house.gov/index.php?option=com_content&task=view&id=315&I
temid=92>  for more information.)

The legislation has been referred to the House Ways and Means Committee
and House Energy and Commerce Committee. 


What You Can Do


Contact your Representative and urge him or her to co-sponsor HR 2829.
You may want to adapt the language in a letter endorsing H.R. 2829
<http://www.bazelon.org/issues/criminalization/takeaction/7-6-09Recidivi
smReduction_letter.doc>  by national advocacy groups, including the
Bazelon Center.

 


Medicaid Services Restoration Act


Senator Debbie Stabenow (D-MI) has reintroduced the Medicaid Services
Restoration Act (S.1217) with Senators March Begich (D-AK) and Blanche
Lincoln (D-AR). The legislation would:

*	Create a new service category to finance therapeutic foster care
for children with serious mental and emotional disturbances. Therapeutic
foster care is the least restrictive form of out-of-home placement for
children with serious mental disorders, and would keep children in their
home community. Trained surrogate parents provide a structured,
therapeutic environment where children receive intensive individualized
Medicaid psychiatric rehabilitation services and learn coping skills and
how to manage the symptoms of their illness.
*	Help individuals with disabilities attain and retain functional
skills by authorizing "habilitation" services under the rehabilitation
option.
*	Allow states to use bundled rates to pay for services through
the rehabilitation option instead of, as CMS insists, accounting and
billing for services in 15-minute increments. Although not specifically
described in the rehabilitation regulation, this denial of payment
through daily rates, case rates and similar arrangements severely
restricts providers' ability to provide evidence-based practices like
assertive community treatment and multi-systemic therapy. The
legislation would also permits efficient and reasonable payment
methodologies under the case management and targeted case management
option.
*	Authorize Medicaid to pay for physical health care for children
who are placed in a 24-hour psychiatric hospital or psychiatric
residential treatment center that provides Medicaid psychiatric
inpatient services for children under 21. This change addresses CMS'
claims that Medicaid law applies only to mental health services provided
to children in these facilities, contradicting Medicaid's EPSDT
requirement that a Medicaid-eligible child receive "all medically
necessary services" under a state plan. 
*	Codify the Olmstead case management standard that permits 180
days of intensive case management services for Medicaid beneficiaries
with disabilities who are transitioning from institutions to the
community.
*	Authorize states to assign case managers to individual Medicaid
beneficiaries, including multiple case managers. 

For more information, see a summary prepared by the Child Welfare League
<http://www.bazelon.org/pdf/7-9-09MedicaidRestoration%20ActSummary.pdf>
. The legislation was first introduced in the last Congress, in response
to harmful Medicaid regulations issued by the Bush Administration (see
the Bazelon Center's October 26,2008 Policy Reporter
<http://www.bazelon.org/newsroom/reporter/2008/10-16-08reporter.htm#3>
). Although the Obama Administration has rescinded the regulations (see
newsbyte), the legislation makes meaningful improvements to Medicaid.

 


Hearings on Sotomayor Nomination to Begin; Vote Likely in August


The Senate Committee on the Judiciary plans to open hearings on
President Obama's nomination of Judge Sonia Sotomayor to the U.S.
Supreme Court on Monday, July 13. The Bazelon Center and more than two
dozen other disability groups sent a letter to the committee leadership
<http://www.bazelon.org/pdf/SotomayorDisabilityGroupsLetter7-07-09.pdf>
, endorsing the nomination, noting that "Judge Sotomayor's decisions
under our seminal civil rights law, the Americans with Disabilities Act
(ADA), have demonstrated a good understanding of - and healthy respect
for - the rights of persons with disabilities." See also a review of
Judge Sotomayor's many decisions
<http://www.bazelon.org/issues/disabilityrights/sotomayor6-11-09.pdf>
involving the rights of people with disabilities. 

The hearing is expected to last all week, with a floor vote likely in
early August to meet the President's desire that the new associate
justice be sworn in well before the start of the court's term in
October. 


What You Can Do


*	If one of your Senators is on the Judiciary Committee, call now
to urge him or her to support Judge Sotomayor's nomination (see list
with phone numbers in our latest Action Alert, Five Things You Should
Know about Judge Sonia Sotomayor
<http://www.bazelon.org/takeaction/2009/7-07SotomayorAlert.htm>  and
Disability Rights
<http://www.bazelon.org/takeaction/2009/7-07SotomayorAlert.htm> ).
*	If not, write to both of your Senators urging them to vote for
Judge Sotomayor's confirmation when her nomination comes to the floor in
a few weeks. 

 


Newsbytes


Harmful Medicaid Rules Rescinded


The Department of Health and Human Services has officially rescinded all
or part of the Medicaid regulations that were issued in final form under
the Bush Administration and suspended by Congress (see CMS press release
<http://www.bazelon.org/pdf/6-29-09CMSRescindsRules.pdf> ). The rules
that were rescinded include all of the Medicaid regulations governing
school-based administration and transportation services, all of the rule
limiting outpatient hospital and clinic services and part of the
December 4, 2007 rule that would restrict access to case management
services.    

The rules were suspended by a congressional moratorium that was set to
expire on July 1, 2009 (see the Bazelon Center's July 7, 2008 Alert
<http://www.bazelon.org/takeaction/2008/7-01-08CMSmoratorium.htm> ). The
Department had released a notice of proposed rulemaking to rescind the
three rules earlier this year and was expected to publish the final
regulation rescinding the rules prior to expiration of the moratorium.  

 


Grassroots Stories Support Healthcare Reform; Will You Add One on the
Need to Include Mental Health?


"Health Care Stories for America"
<http://stories.barackobama.com/healthcare/>  is the newest section on
the Obama grassroots website, Organizing for America
<http://www.barackobama.com/> . It features an interactive map of the
United States with links to stories people have sent to illustrate the
dreadful problems with our current healthcare system. If you have a
story (your own or another's) that illustrates the dire need to
integrate mental health with healthcare coverage in any reform -and to
make coverage accessible and affordable-why not add it? A megaphone icon
at bottom left of the page offers a way to boost the prospects of your
story, or any other that you choose, of being featured on the map. 

These stories will be invaluable to convince legislators and the public
(remember the Harry and Louise commercials that sank health reform in
1993) of the need for real reform. If you submit a story, please copy it
for the Bazelon Center, sending to leec @ bazelon.org
<mailto:leec at bazelon.org>  (close the spaces). 

 

http://www.bazelon.org/newsroom/reporter/2009/7-9-09reporter.htm 

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