Mental Health ParityMENTAL HEALTH PARITY

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AACAP FEDERAL LEGISLATIVE UPDATE

Department of Government Affairs 2nd Session

Kristin K. Ptakowski, Director, Government Affairs 110th Congress Elizabeth Rorick, Assistant Director, Government Affairs 110-24

Kevin Jones, Assistant Director for State Advocacy

Pat Jones, Legislative Assistant

AACAP Department of Government Affairs

Legislative Update

AACAP Advocacy Day

On April 4th, the AACAP held its’ third annual Advocacy Day, in Washington D.C.  More than 100 child and adolescent psychiatrists, accompanied by 25 family members affected by mental illness, educated federal legislators about the necessity of improving children's access to mental health care.

Advocacy Day 2008 events kicked off with a Congressional Reception in Rayburn House Office Building. During the reception, AACAP honored Senator Jeff Bingaman (D-NM), Representative Tim Murphy (R-PA), Representative Grace Napolitano (D-CA), and Connie Garner, Policy Director for Senator Kennedy for championing children’s issues in the 110th Congress. The AACAP Delegation of advocates attended more than 150 meetings with Senate and House staff.

The AACAP thanks everyone who participated in AACAP Advocacy Day 2008. We hope more AACAP members will join us for Advocacy Day 2009. Stay tuned for more information.

Chris Bellonci, M.D., testifies on Capitol Hill

On April 24th, the House Education and Labor Committee held a hearing to examine allegations of child abuse and deceptive marketing at residential programs for teens, including boot camps, wilderness camps, therapeutic boarding schools, and behavior modification facilities. The hearing also examined the Stop Abuse in Residential Programs for Teens Act of 2008 (HR 5876) which aims to prevent child abuse in these programs by establishing standards for the programs. Chris Bellonci, M.D. told the committee that “when parents are searching for appropriate interventions and treatment (outside of the home/community environment) it is difficult as there is a large issue with appropriate accreditation of these programs, a lack of child and adolescent psychiatrists, limitations on mental health insurance and stigma.” 

The Stop Abuse in Residential Programs for Teens Act of 2008 would:

• Keep teens safe with new national standards for private residential programs

• Prevent deceptive practices by residential programs for teens

• Hold teen residential programs accountable for violating the law

• Ask states to step in to protect teens in residential programs

To view a video of the hearing go to    

Click here to view a copy of Dr. Bellonci’s testimony.

Mental Health Parity

Both the House and Senate introduced mental health parity legislation that closes the loopholes that permit healthcare plans to charge higher co-payments, coinsurance, deductibles, and maximum out-of-pocket limits and impose lower day and visit limits on mental health and addiction care. Neither bill mandates coverage of mental health and substance use benefits.

There are differences between the two bills. The Senate bill allows group health care plans to determine the definition of "mental health benefits" or, when applicable, to be defined under State law.  The House version requires health plans which offer mental health benefits to provide the same mental health benefits and substance use disorders benefits that are included in the Federal Employees Health Benefit Program (FEHBP).

Senate legislation

The Senate bill has undergone several iterations, most notably, the removal of any state preemption language.  The Senate bill passed the Senate by unanimous consent on September 18th.

  

House legislation

The House passed their version of the mental health parity bill on March 5th.

On March 18th, the Senate cosponsors, Senators Kennedy and Domenici, submitted a mental health parity compromise proposal to the House for approval. Congressional staff indicates that a House counter-offer is currently being drafted by House legislative counsel. The mental health community hopes that Congress will reach a compromise and a bill will be passed into law during the second session of the 110th Congress.

Child Health Care Crisis Relief Act

The Child Health Care Crisis Relief Act, was reintroduced for the 110th Congress in the House of Representatives by Reps. Patrick Kennedy (D-RI) and Ileana Ros-Lehtinen (R-FL) and in the Senate by Senators Jeff Bingaman and Susan Collins (R-ME). The new bill numbers are H.R. 2073/ S.1572.   

The Child Health Care Crisis Relief Act addresses the critical national shortage of child and adolescent psychiatrists and other children’s mental health professionals by creating education incentives to encourage recruitment into these fields. For child and adolescent psychiatry training programs, the legislation would extend Medicare graduate medical education (GME) funding support for two years after general psychiatry, and create a loan forgiveness program for use by child and adolescent psychiatrists. Other mental health professionals eligible for the scholarships, loan forgiveness and training grants in the bill include psychologists, social workers, psychiatric nurses, marriage and family therapists, behavioral pediatricians, and all school-based professionals, such as school psychologists, school social workers and school counselors. The bill would cost $45 million annually for 4 years.

Currently, the bill has 17 Senate cosponsors and 22 House cosponsors. The AACAP continues to visit Congressional offices in an effort to garner additional support and cosponsors. AACAP has targeted several pieces of legislation that could act as a possible vehicle for the bill in 2008.

Appropriations

Fiscal Year 2009 research and development funding was one of the priorities of the AACAP Department of Government Affairs Advocacy Day.

National Institutes of Health

Under the Bush Administration’s FY 2009 budget proposal, the National Institutes of Health (NIH) would not receive a funding increase from the FY ’08 budget. Most of NIH’s institutes and centers’ budgets would remain flat for the fifth year in a row, with no allowance for inflation. Furthermore, NIH Research and Development grant funding at the National Institutes of Mental Health, National Institute on Drug Abuse, and National Institute on Alcohol Abuse and Alcoholism would also remain flat at $28.7 billion.

The AACAP has endorsed the Mental Health Liaison Group (MHLG) FY 2009 budget and appropriations document. The MHLG is a coalition of over 50 mental health organizations that form cooperative advocacy efforts, coordinate strategies and discuss public policy issues related to mental health. Specifically, the MHLG appropriations document requests a substantial increase in FY ‘09 funding for the National Institutes of Mental Health, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism.

Substance Abuse and Mental Health Services Administration

The Administration’s FY 2009 proposal will cut $198 million in SAMHSA funding. This cut would eliminate or severely weaken many important programs. Programs slated for elimination include the Mental Health Transformation State Incentive Grants, Minority Fellowship program, and the consumer and family network grants. Programs slated for a decrease in funding include Community Mental Health Services Performance Partnership Block Grants and Programs of Regional and National Significance for mental health, drug abuse treatment, and drug abuse prevention, such as the youth violence prevention, suicide prevention. The Children’s Mental Health Services Program has seen an increase, however due to multiple years of level or decreased funding additional funding is needed. AACAP is working to ensure that the programs receive the necessary amount of funding.

SAMHSA Reauthorization

The reauthorization of the Substance Abuse and Mental Health Services Administration (SAMHSA) was expected to take place during the second session of the 110th Congress. However, charitable choice provisions have caused a delay in the reauthorization process. SAMHSA’s charitable choice provisions ensure that religious organizations are able to compete on an equal footing for Federal substance abuse funding administered by SAMHSA without impairing the religious character of such organizations and without diminishing the religious freedom of SAMHSA beneficiaries. These provisions apply to recipients of the Substance Abuse Prevention and Treatment (SAPT) Block Grant funds, the Projects for Assistance in Transition from Homelessness (PATH) formula grant funds, and to discretionary grant funds for substance abuse prevention and treatment services.

School based mental health services has been included in the preliminary SAMHSA draft that was released by the Senate Health, Education, Labor, and Pensions (HELP) Committee in early December. The preliminary SAMHSA draft also included bill language that awards competitive matching grants to states to establish systems of care to treat and provide services to children who are in the custody of the state or at-risk of entering into the custody of the state for the purpose of receiving mental health services.

State Children’s Health Insurance Program (SCHIP)

SCHIP programs exist in every state and insure more than 6 million children whose families earn too much to qualify for Medicaid but cannot afford private coverage. Many members of 110th Congress placed reauthorizing and improving SCHIP at the top of their agendas. Congress passed and the President signed into law legislation extending SCHIP through March 31, 2009, with sufficient funding to maintain current enrollment and avoid shortfalls. This law also contains a six-month moratorium on the proposed Medicaid Rehabilitation Services regulation. The House failed by 15 votes to override President Bush's veto of H.R. 3963, a bipartisan bill that would have increased SCHIP funding to cover an additional 4 million children.

Juvenile Justice and Delinquency Prevention Act (JJDPA) Reauthorization

Established in 1974 and reauthorized in 2002, the Juvenile Justice and Delinquency Prevention Act (JJDPA) is based on a broad consensus that children, youth and families involved with the juvenile and criminal courts should be guarded by federal standards for care and custody, while also upholding the interests of community safety and the prevention of victimization.

On December 5, 2007, the Senate Judiciary Committee held a hearing on the JDDPA. It was the first such hearing in eight years and signaled the Senate's growing interest in reauthorizing the legislation. The core protections that drew the most discussion were removing youth from adult jails and prisons, not allowing status offenders to be placed in detention, and the provision on addressing the racial and ethnic disparities in the juvenile justice system. The Senate is expected to release a draft of the JDDPA legislation in summer 2008. The AACAP Department of Government Affairs is working with several child welfare and juvenile justice organizations to see that this important measure is reauthorized in 2008.

Invest in KIDS Act

Representative Jim McDermott (D-WA) has introduced the Invest in KIDS Act, H.R. 5466. The bill would reauthorize the current adoption incentive fund, which is due to expire, and seek to better promote the use of adoption tax credits to lower income families, especially foster families. The bill would require states to have better health planning with the state Medicaid agency and would also require states to have plans that would allow a child in foster care to remain in his or her school of origin when it's in the best interest of the child, or when the child has to relocate, they would be allowed immediate admission into a new school. This bill advances many of the key principles for a major reform proposal: federal support for all children in care, more flexibility in the use of funds to provide key services, support for kinship families, expanded access to federal funds by tribal communities, expanded support for youth, and funding to address the workforce shortage in child welfare.

July Recess District Meetings

You do not need to come to Washington, DC to meet with your Representative or Senators. The AACAP Department of Government Affairs is glad to coordinate congressional district office visits for you. The AACAP will schedule the meeting, provide you with briefing materials and talking points on the issues and find other AACAP members/family members to accompany you in a strong children’s mental health delegation. All you have to do is attend the meeting!

If you are available to attend a district visit, please contact the AACAP Department of Government Affairs, as visits need to be scheduled in advance. Please contact Pat Jones, AACAP Legislative Assistant, at pjones@ or call 800.333.7636, ext. 128, to schedule your district visit today!

May is Mental Health Month

Congress has officially recognized May as Mental Health Month since 1949. On May 8th, communities across the country will conduct a variety of activities to focus attention on addressing the mental health needs of youth to ensure their total well-being in honor of National Children's Mental Health Awareness Day. The Substance Abuse and Mental Health Services Administration (SAMHSA) is sponsoring, “STILL I RISE: A Celebration of Resiliency through the Performing Arts,” in Washington, DC. This flagship event will feature six to eight talented youth from the Washington, D.C. area that will use the performing arts to share lessons learned from overcoming life’s challenges. The event will be co hosted by Keke Palmer of Akeelah and the Bee and Mark Indelicato from ABC’s Ugly Betty. Football Hall of Famer Herschel Walker will receive an award of special recognition.

For more information on these exciting events, please contact the AACAP Department of Government Affairs.

Important Upcoming 2008 Dates:

Month of May: Mental Health Month

Mary 8th: National Children’s Mental Health Awareness Day

May 15: Target date for House to begin passage of 12 appropriations bills

June 27: Target date for House to complete work on appropriations

June 30th-July 4th: Fourth of July Recess

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