This legislative year started with a change in leadership within Congress. For the first time in several years, the Democrats controlled both the House and Senate. The issues of health care reform and mental health were on lawmaker’s minds. This was a great opportunity to advance mental health policy, including AACAP’s agenda to provide improved access and services for children with mental illnesses, increases in research funding and equal health care for persons living with mental illness. However, there were also many other competing policy issues that lawmakers needed to grapple with and unfortunately, some legislation was held up due to differences between the House and Senate as well as vetoes by the President.

Included in this email is an end of the year legislative update on all of the bills that affect child and adolescent psychiatry and children’s mental health issues. Please feel free to contact any member of the AACAP Government Affairs staff if you have any questions.

Happy Holidays from the AACAP Department of Government Affairs!

Mental Health Parity

Mental health parity legislation has taken the front seat over other mental health policy in the 110th Congress. 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, which means that neither bill requires mental health or substance use disorder coverage, but when such coverage is provided, it must be at parity.

However, there are differences between the two bills. Most notably, 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 offering mental health benefits to cover the same mental health benefits and addiction disorders 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 bill has been voted out of all three committees of jurisdiction and is currently awaiting a full House vote.

It is the hope of the mental health community that all concerns surrounding the mental health parity bill will be resolved and a bill will be passed in during the second session of the 110th Congress which convenes in January 2008.

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 15 Senate cosponsors and 20 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.

SCHIP

The current state of the State Children’s Health Insurance Program (SCHIP), which covers about 6 million children whose families are low-income but not poor enough to qualify for Medicaid, remains uncertain. Even though Congress passed two bills to expand SCHIP, President Bush vetoed Congress's first bill (H.R. 976), citing the bill's price tag and its method of payment as problematic. Congress sent its second reauthorization bill (H.R. 3963), which sought to address opponents' concerns, to the President on November 30, which he vetoed on December 12th. Following the veto, Speaker of the House, Nancy Pelosi, offered a resolution to delay a veto override vote until January 23, 2008. The motion was agreed to by a margin of 211-180.

Both SCHIP bills would have increased federal funding for SCHIP by $35 billion over five years, for a total of about $60 billion. The SCHIP bills included a 61-cent tax increase on a pack of cigarettes to help fund the program's expansion. Both bills would have maintained current enrollment for more than 6 million children and encompassed nearly 4 million additional children in either Medicaid or SCHIP, most of which are already eligible for these programs. The bills included mental health parity for children enrolled in all SCHIP benchmark plans.

Throughout the fall, lawmakers continued to meet and negotiate on the terms of a long-term reauthorization. SCHIP officially expired September 30 and continued to operate through continuing resolutions, the last of which expired December 14. On December 19th Congress passed a bill that the President is expected to sign that will continue the SCHIP program in its current form until March of 2009. Despite their failure to expand the program to cover 10 million children, some expect congressional leaders to continue the fight for the program’s expansion through the early part of 2008.

The previous bill included potential cuts in Medicare physician payments. The extension bill ensures that people with disabilities can continue to see the doctors of their choice by blocking a scheduled 10.1% payment cut to doctors on January 1, 2008 and replacing it with a 0.5% increase through June 30, 2008.

Appropriations

Congress has passed an omnibus budget bill that includes funding levels that are slightly above the FY 2007 level for most health agencies and programs, and significantly above the President's budget request. As of December 20th, NIH is expected to receive $29.2 billion ($392 million above 2007). The Substance Abuse and Mental Health Services Administration (SAMSHA) is expected to receive $3.4 billion ($29.7 million above 2007). The Center for Mental Health Services (CMHS) is expected to receive an increase of approximately 3% above FY 2007. However, despite the increase, many of CMHS programs absorbed a cut due to the 1.747% cut of all discretionary spending that was used to get down to the President’s-approved level of $933B (for all discretionary spending). More specific numbers will be available on our web site early next year.

Other Legislative Action Expected in 2008

SAMHSA Reauthorization

The reauthorization of SAMHSA is expected to take place during the second session of the 110th Congress. The Senate Committee on Health, Education, Labor and Pensions, which is chaired by Senator Edward Kennedy (D-MA), is tentatively scheduled to vote on the legislation on January 23rd. SAMSHA administers a combination of formula, competitive, and block grants programs and data collection activities that are carried out through the Center for Mental Health Services (CMHS); the Center for Substance Abuse Prevention (CSAP); the Center for Substance Abuse treatment (CSAT); and the Office of Applied Studies (OAS).

School based mental health services (S. 1332) 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 includes 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.

School Based Mental Health Services

Senators Edward Kennedy (D-MA) and Pete Domenici (R-NM) introduced the Senate version of the Mental Health in Schools Act, S. 1332. Congresswoman Grace Napolitano (D-CA) introduced the House version of this bill, H. 3430.

The measure would amend the Safe Schools/Healthy Students Act to provide better opportunities for public school children get the mental health services they may need. It authorizes a competitive grant program to support comprehensive school-based mental health programs for students in grades K-12. Grantees would be required to develop comprehensive mental health services programs that:

• Promote the social, emotional, and behavioral health of all students and facilitate an environment conducive to learning;
• Reduce the likelihood of developing social, emotional and behavioral health problems for at-risk students;
• Treat existing social, emotional and behavioral health problems of students already experiencing such problems; and
• Develop systems of care to assist children in dealing with violence.

AACAP members and staff were instrumental in working with Senator Kennedy’s staff to draft this legislation. The AACAP owes a special thank you to our Schools Committee for their feedback on this legislation.

Juvenile Justice and Delinquency Prevention Act (JJDPA) Reauthorization

Established in 1974 and authorized 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, 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 January. 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.

NEW AACAP Congressional Fellowship Program
The American Academy of Child and Adolescent Psychiatry (AACAP) is pleased to announce the AACAP 2008 Congressional Fellowship Program. The AACAP Congressional Fellowship Program is designed to educate policy makers and Congressional staff about child and adolescent psychiatry and to foster awareness of children’s mental health issues. This experience will allow the Fellow to develop a keen understanding of how public policy affects patient care, education, and health insurance issues. The 2008 AACAP Congressional Fellow will be placed with a Congressional office or Committee where they will gain invaluable experience as they assist in the development of legislative and public policy initiatives.

The program will begin in September 2008 and end in late July 2009. A one week orientation at the AACAP office will be provided by the AACAP Department of Government Affairs. The award includes an $85,000 stipend, up to $3000 in relocation costs, and health insurance costs for the duration of the fellowship.

The AACAP is currently accepting applications until February 1, 2008. The top 3 candidates will undergo face-to-face interviews by a selection committee and the AACAP Director of Government Affairs in early March 2008. Notification of the award will be given in early April 2008.

Please see below for more information on the fellowship.
http://www.aacap.org/cs/root/legislative_action/2010_congressional_fellowship_program 

If you have any additional questions, please contact Kristin Kroeger Ptakowski at kkroeger@aacap.org.

2008 Lifelong Learning Institute

Make plans to attend the 2008 Lifelong Learning Institute!

The AACAP will be hosting an Advocacy Day as part of 2008 Lifelong Learning Institute on Thursday February 7th. This is a unique opportunity for you to lobby your elected officials on issues related to children’s mental health and child and adolescent psychiatry. The day will consist of a lunch briefing by the AACAP Department of Government Affairs on the issues you will be advocating followed by meetings with your Senators and Members of Congress and/or their staff. Please don’t miss your chance to let you voice be heard!
For more information, please see the link:

http://www.aacap.org/cs/LifeLongLearning2008

Holiday Recess Congressional Meetings

This recess is the perfect time to schedule a district office visit with your Representative and Senators to request their support for the AACAP’s priority legislation, the Child Health Care Crisis Relief Act, H.R. 2073/S.1572. This is also the opportune time to urge your members of Congress to vote in support of the SCHIP legislation.

The AACAP Department of Government Affairs will be glad to coordinate congressional district office visits for you, including scheduling the meeting, providing you with briefing materials and talking points on the issues and finding 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 in early January 2008 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@aacap.org or call 800.333.7636, ext. 128, to schedule your district visit today!

Important Upcoming 2008 Dates:
January 15th: House convenes for Second Session of 110th Congress
January 22nd: Senate convenes for Second Session of 110th Congress
January 28th: State of the Union Address
February 4th: President’s proposed budget submitted to Congress
February 7th: 2008 AACAP Lifetime Learning Institute, Advocacy Day
April 4th: 2008 AACAP Hill Day