National Alliance on Mental Illness
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November 20, 2002

Congress Moves Toward Final Adjournment

Action on Mental Illness Parity and FY 2003 Spending Bills Put Off Until January, 1996 Parity Law Extended, Social Security Measure
Still Under Consideration

Congress has begun a final push toward completion of a short "lame duck" session without acting on spending bills for the current fiscal year or a popular measure to require health plans to cover treatment for mental illnesses on the same terms and conditions as all other illnesses. In fact, the only major action that is likely to be passed in this "lame duck" session is President Bush's proposal to establish a new cabinet level Department of Homeland Security. This means a large volume of legislation will be put off until the new Congress convenes in January 2003.

Action on Mental Illness Parity Stalled

Unfortunately, this very brief "lame duck" session failed to produce an opportunity for members of Congress to push for a range of popular bills that had broad bipartisan support in both the House and Senate. The mental illness parity bill (S 543/HR 4066) was part of a long list of bills that were not acted on during the "lame duck" session and will have to wait until next year (this list includes bankruptcy reform, restoration of cuts to hospitals and doctors serving Medicare beneficiaries and energy reform). It is important to note that few of these bills enjoy the strong bipartisan support that parity does in both the House and Senate and, most importantly, from President Bush. During the 107th Congress (2001 and 2002) few bills matched the record of accomplishment of the mental illness parity measure:

  • vocal support from President Bush,
  • 67 Senate cosponsors (over two-thirds of the Senate), and
  • 243 House cosponsors (over half the House).

NAMI is especially grateful to the key leaders in Congress that pushed so hard for action on parity this year: the late Senator Paul Wellstone (D-MN), Senator Pete Domenici (R-NM) and Representatives Marge Roukema (R-NJ) and Patrick Kennedy (D-RI). NAMI is also grateful for President Bush's public support for action on federal parity legislation. Despite this broad bipartisan support for parity, there are still pockets of important opposition to parity (mainly from employer and insurance groups) that must be overcome. NAMI advocates are therefore strongly encouraged to contact their members of Congress between now and January and urge them to support passage of mental illness parity when the new 108th Congress convenes early next year.

1996 Law Extended

On November 15, both the House and Senate cleared legislation (HR 5716) extending the 1996 federal Mental Health Parity Act for an additional year ¬Ė through December 31, 2003. The 1996 law requires only for annual and lifetime dollar limits and is therefore far more limited than protections in S 543/HR 4066 that require parity for all treatment limitations (both inpatient and outpatient), cost sharing, deductibles and other financial limitations that apply only mental illness treatment. In 2001, Congress took similar action to extend the 1996 law for one year when it originally expired on September 30, 2001. President Bush is expected to sign HR 5716 into law when it reaches his desk.

FY 2003 Spending Bills Remain Unresolved

The major unfinished business for Congress in this "lame duck" session was the remaining appropriations bills for FY 2003 (which actually began on October 1, 2002). Currently, federal agencies and programs are operating under a "continuing resolution" that will keep the government running through January 11, 2003. This "continuing resolution" will maintain last year's spending levels until Congress acts on the remaining FY 2003 appropriations bills next year.

Included in these unfinished spending bills is the Labor-HHS-Education Appropriations measure (HR 5320/S 2766) that includes funding for the National Institute of Mental Health (NIMH) and the Center for Mental Health Services (CMHS). Increases for both of these agencies are included in the Labor-HHS- Education spending bill; most importantly, a 7.8% increase for mental illness research at NIMH (raising FY 2003 funding to $1.359 billion). For CMHS (part of the federal Substance Abuse and Mental Health Services Administration), the Senate bill includes a $7 million increase for the PATH program (services for homeless individuals with mental illness) and level funding for the Mental Health Block Grant ($433 million). For reater details on the pending Labor-HHS spending bill†see.

Funding for housing and veterans programs are part of a separate spending measure known as the VA-HUD Appropriations bill (HR 5605/S 2797) for which Congress has not completed action. It includes a $2.56 billion increase for veterans' medical care (including treatment and supportive services for veterans with mental illness). Both the House and Senate VA-HUD bills also contain funding for important housing programs at HUD including the McKinney- Vento Homeless programs, Section 811 supportive housing and the Section 8 rental voucher program. This includes funding to renew all expiring rent subsidies under the Shelter Plus Care program (permanent supportive housing for chronically homeless individuals with mental illness and co-occurring substance abuse disorders) and the Section 811 program (both tenant-based and project- based subsidies).†View†for more details of the FY 2003 VA-HUD Appropriations bill.

It is unlikely that the fate of these FY 2003 spending bills will be resolved (even when the new Congress convenes) until congressional leaders and the Bush Administration reach an agreement on overall levels for federal discretionary spending. The start of a new Congress will also require the House and Senate Appropriations Committees to reintroduce the Labor-HHS and VA-HUD bills in January. More importantly, by delaying action on any of these spending bills until at least mid-January (or perhaps later), Congress and the Bush Administration have put off important federal priorities such as development of new mental illness research grants at NIMH, and renewal of key local services programs, (e.g., CMHS community action grants that many NAMI affiliates are engaged in).

Social Security Reforms Clear the Senate, House Action Uncertain

While action on most major bills besides the new federal Homeland Security Department were delayed until next year, there were numerous attempts behind the scenes to move smaller legislation through unanimous consent. Passage of bills by unanimous consent is difficult since any single member of Congress can block action. In the waning days of the current session, hundreds of bills are moving through by unanimous consent (including HR 5716). One such measure that supporters are still hoping to get through is the Senate version of a previously passed House bill (HR 4070) making reforms to Social Security’s disability programs.

HR 4070 includes important new protections for vulnerable SSI and SSDI beneficiaries with severe mental illnesses that have a representative payee. This includes expanded authority for the Social Security Administration (SSA) to repay SSI beneficiaries when an organizational, or other large representative payee, misuses a beneficiary's funds. The bill would also increase oversight of representative payees by requiring annual proof of licensing and bonding for non-governmental fee-for-service organizational representative payees and periodic onsite reviews of certain representative payees. Further, under the legislation certain organizational representative payees would have to forfeit their fee for months in which the representative payees misused a beneficiary's funds.

HR 4070 would also require SSA to issue receipts to beneficiaries that report changes in earnings or work status, thereby assisting SSDI beneficiaries in being able accurately track their use of Trial Work Periods months. This reform is coupled with a change that would disqualify SSDI beneficiaries convicted of fraudulently concealing work activity during the Trial Work Period from receiving benefits for that period.

Finally, HR 4070 contains several technical changes to the 1999 Ticket to Work and Work Incentives Improvement Act (TWWIIA) including new authority for Protection & Advocacy (P&A) programs to help beneficiaries that are working to "maintain" their employment and to allow Benefit Planning, Assistance, and Outreach (BPAO) grantees to serve people who are no longer in cash benefit status (and thereby help as many people work successfully as possible). Further, HR 4070 grants SSA new authority to begin the required $1 for $2 demonstration program for SSDI beneficiaries.

Action Requested

NAMI supports passage of protections for SSI and SSDI beneficiaries contained in the Senate-passed version of HR 4070. NAMI advocates are strongly encouraged to call or e-mail their House member and ask them to urge the House leadership to allow the Social Security Program Protection Act, HR 4070 to pass by unanimous consent this week. The Senate passed a compromise version of HR 4070 earlier this week. Earlier this year, the House passed its version of the bill 425-0. The key Republican and Democratic sponsors in both the House and Senate have accepted the differences in the Senate version. The last step left is to clear the Senate bill through the House and allow HR 4070 to go to President Bush for signature. Unfortunately, House leaders are have indicated that they are considering limiting further use of unanimous consent agreements to clear Senate passed bills - a move that would kill two years of efforts to pass these protections for SSI and SSDI beneficiaries.

All members of Congress can be reached by calling the Capitol Switchboard toll free at 1-800-839-5276 or at 202-224-3121 or online through