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March 8 — A better mental health care system is the goal of a draft bipartisan bill released by a Senate panel, in advance of a March 16 markup.
The bill from the Senate Health, Education, Labor and Pensions Committee is narrower in scope than a similar effort under way in the House (H.R. 2646), which has been stalled for months. The Senate draft seems to have more support and could move forward much easier than the House version. The draft was released March 7.
The Senate draft would require the Substance Abuse and Mental Health Services Administration (SAMHSA) to hire a chief medical officer and to report to Congress every two years on its activities. The draft bill also would reform the state mental health grant system and includes provisions to address provider workforce shortages.
A manager's amendment making final additions to the bill, along with legislation to combat the opioid epidemic, is expected to be released in time for a HELP Committee markup slated for March 16.
“One in five adults in this country suffers from a mental illness, and nearly 60 percent aren’t receiving the treatment they need,” HELP Committee Chairman Lamar Alexander (R-Tenn.) said in a March 7 statement.
The bill would increase access to care for individuals including veterans, homeless individuals, women and children. It also seeks to improve the training for those who care for people with mental illnesses, and promote better enforcement of existing mental health parity laws. The draft also aims to improve coordination of mental health programs across the federal government.
Unlike the House legislation, the Senate draft steers clear of controversial areas like assisted outpatient treatment and large changes to the Health Insurance Portability and Accountability Act (HIPAA) privacy provisions. The House bill would provide funding incentives to encourage states to adopt assisted outpatient treatment (AOT) laws, which allow judges to force people with mental illnesses into treatment. It also would make it easier to for providers to share protected health information with caregivers.
The Senate draft would direct the administration to provide resources to ensure providers, patients and families know what the HIPAA regulations are. It avoids any mention of AOT laws. Avoiding those issues should make the bill's passage smoother.
“I think that the mental health bill has been very bipartisan in conception,” Sen. Bill Cassidy (R-La.), one of the bill's co-sponsors, told Bloomberg BNA March 8. “I don't think people are going to be throwing a wrench into it from either side.” He specifically mentioned the HIPAA provisions as one example of how the Senate could move forward while the House remains at an impasse.
However, the primary sponsor of the House legislation slammed the Senate effort. In a March 8 statement, Rep. Tim Murphy (R-Pa.) said lawmakers shouldn't abandon important reforms just to pass a bill.
“When it comes to transforming the hopelessly failed federal mental health system, we can make a deal or make a difference,” Murphy said in the March 8 statement. “To abandon House reforms supported by a bipartisan coalition of 185 members would be tantamount to abandoning patients with seriously mental illness and those who have devoted their lives to care for them.”
The way forward is complicated. Once the Senate bill clears the committee after the markup, it will be combined on the Senate floor with efforts from the Senate Judiciary Committee and the Finance Committee.
The addition from the Finance Committee would repeal the prohibition on Medicaid paying for the care of anyone over the age of 21 and under 65 who resides in an institution for mental diseases (IMD), even for treatment unrelated to mental illness. The so-called IMD exclusion would be very costly to repeal, but is seen by many advocates as a major barrier to treating mental illness.
Sen. Christopher S. Murphy (D-Conn.), another sponsor of the Senate legislation, told Bloomberg BNA before the draft was released that funding for pieces of the bill like the IMD exclusion will be critical.
“It’s hard to say you’re making a dent in the mental health crisis without any resources,” Sen. Murphy said in a March 2 interview. “I think it’s a judgment call whether our mental health bill is worth doing without new resources, and we’ll have to wait until the floor until we’ll know whether or not it’s worth proceeding if we’re not successful in getting resources.”
The HELP Committee also is negotiating with the Judiciary Committee in an effort to incorporate the Mental Health and Safe Communities Act (S. 2002). That bill, sponsored by Sen. John Cornyn (R-Texas) seeks to improve mental health treatment for people facing imprisonment. The measure is controversial because Democrats object to a provision they say would make it easier for mentally ill people to get guns.
Cornyn told reporters March 8 he will encourage Judiciary Committee Chairman Charles Grassley (R-Iowa) to have a separate markup of S. 2002 and then find a way to merge it with the HELP bill.
Cornyn said he doesn't understand Democrats' objections, and plans to keep the provision about gun background checks.
Sen. Murphy told Bloomberg BNA he understands how complicated it seems to make sure all the right pieces come together.
“It’s admittedly a very tricky dance, but if you think about the things that have enough bipartisan support to pass this year, this bipartisan mental health bill is on a very short list,” Sen. Murphy said.
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Text of the draft bill is at http://src.bna.com/c8k.
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