Mental Health Legislative Action Expected in 2004
February 20, 2004
Congress plans extensive breaks this year for campaigning, but has an ambitious agenda for mental health-related legislation. Following are high priority bills NASW is pursuing in the limited number of legislative days leading up to this fall's general election.
Medicare: Clinical Social Work Equity
Section 4432 of the Balanced Budget Act of 1997, through the creation of the Prospective Pay System (PPS) for Medicare SNFs, revoked clinical social workers' ability to bill Medicare directly for psychotherapy services rendered in a SNF setting. Section 4432 failed to exempt clinical social workers from the PPS, in contrast to physicians and psychologists, who are statutorily exempt, and thus do not face such restrictions.
NASW Advocacy
NASW has strongly advocated for legislation that would remedy this problem. The Clinical Social Work Medicare Equity Act of 2003 (HR.707/S.343), sponsored by Reps. Pete Stark (D-CA) and Jim Leach (R-IA), along with 31 House cosponsors, and by Sen. Barbara Mikulski (D-MD), along with seven Senate cosponsors would rectify this inequity. It would restore the ability of clinical social workers to bill Medicare Part B directly for services furnished to SNF patients nationwide. NASW has targeted key Republican members of the Senate and House committees with jurisdiction over Medicare. NASW is currently working closely with its chapters on target congressional offices and building influential support for the legislation.
Medicaid: Threatened Anew
The President's budget again calls for reductions in projected Medicaid expenditures. However, it does not call for passage of last year's proposal to eliminate Medicaid's entitlement and replace it with a block grant program. It also calls for federal regulators to crack down hard on states' alleged abuse of Medicaid payment policy.
In addition to federal budget pressures, state governments face yet another extremely difficult year meeting their Medicaid budget requirements. One action that would help greatly is the extension of federal fiscal relief to temporarily increase the federal Medicaid contribution to the states, thus protecting Medicaid and SCHIP coverage and avoiding cuts that would deny essential care to recipients.
Public mental health services are particularly vulnerable to Medicaid cuts as the services are largely all provided at the option of individual states, and public mental health services are heavily dependent upon Medicaid revenue in most states.
NASW Advocacy
NASW — along with consumer advocates, other providers, insurers, employers and state and local officials — supports the extension of federal fiscal relief for states. Calls for the extension of federal relief have already begun. NASW is working with a coalition to urge Congress to include fiscal relief for states in the congressional budget resolution. NASW is also working to educate congressional leaders about how Medicaid funds support mental health services and how vulnerable these populations and services are to cutbacks.
SAMHSA Appropriations
With few working days in the congressional calendar this year, prospects of appropriations being completed by the Oct. 1 deadline are slim. Many observers expect a lame duck session after the November election, and a temporary funding resolution for the early months of the fiscal year. The President's budget request for SAMHSA allows a six percent increase over the current year, well ahead of what was proposed for other HHS agencies. A portion of this increase is in response to recommendations of the President's New Freedom Commission on Mental Health.
NASW Advocacy
NASW is working with a coalition of mental health organizations to conduct Hill visits in support of SAMHSA. Our appropriations support will be necessary for the entire year. Working with a broader coalition, NASW is actively seeking an increase in the entire portion of the congressional budget resolution allocated to public health activities.
Mental Health Parity
The Senator Paul Wellstone Mental Health Equitable Treatment Act (S. 486/HR. 953) requires health plans to cover treatment for mental illness on the same terms and conditions as all other illnesses (insurance parity). Despite broad congressional support for the legislation, momentum toward passage slowed in both chambers during 2003. Recently, bipartisan leaders in the Senate made a commitment to bring mental health parity to the floor early this year, to ensure there is adequate time for House consideration later in the year.
NASW Advocacy
NASW supports full parity in both private (individual and employer-based) and public (Medicare, Medicaid, and other government-sponsored) insurance coverage for mental illnesses. More than 270 national organizations support the legislation, and NASW has participated in a national grassroots mobilization effort to support the measure. The Senate HELP Committee is expected to approve the bill within the next two months. NASW will actively support this Senate effort in the coming months.
Association Health Plans
President Bush is putting strong pressure on the Senate to pass the Small Business Health Fairness Act, S.545 this year, as a part of his health care agenda. The House version (H.R.660) passed last year, largely along a party-line vote. S.545 aims to provide small businesses, including associations, with lower cost and bare bones health insurance for their employee groups through association health plans (AHPs). NASW is highly supportive of increasing access to health care coverage for working people, but we oppose S.545 because it would exempt AHPs from state laws and regulations, eviscerate behavioral health and other mandatory benefits, eliminate consumer protections, and increase health insurance costs for employee groups left out of the new plans.
NASW Advocacy
NASW and our coalition partners are concerned that the Senate bill could pass under election-year pressure. NASW has been working with a large coalition of organizations opposed to this legislation. We are currently contacting Senators to oppose to S.545. Please call, fax, or e-mail your U.S. Senator and ask him or her to oppose the Small Business Health Fairness Act, S.545. A sample letter opposing the bill — which you can e-mail or fax to members of Congress — has been posted on NASW's Congress Web: http://www.socialworkers.org/advocacy/alerts/021904.asp |
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