June 27, 2003
House and Senate Begin Work on FY 2004 Spending Bill for Mental Illness Research and Services Programs
This past week Congress began action on spending legislation for mental illness research and services for the coming federal fiscal year that will begin on October 1. The massive FY 2004 Labor-HHS-Education Appropriations bill (nearly $138 billion) includes important increases for mental illness research and services programs, including the National Institute of Mental Health (NIMH) and the Center for Mental Health Services (CMHS). This week both the House and Senate Appropriations Committees approved the measure. The full House and Senate will take up their versions of the Labor-HHS-Education bill after the upcoming July 4th recess.
Both the draft House and Senate bills are below the overall amount requested by President Bush for FY 2004 – the Senate bill by more than $440 million. The result is that while most programs and agencies funded under Labor-HHS-Education bill enjoy bipartisan support in Congress, overall constraints on discretionary spending for FY 2004 have forced freezes or actual reductions in spending levels. It also important to note that these overall limits restraining discretionary spending were agreed to by Congress this past spring in the FY 2004 budget resolution. Until the overall limits on spending imposed on the Labor-HHS-Education Appropriations bill are increased by House and Senate leaders and Bush Administration, it will be very difficult for supporters in Congress to add additional funds for FY 2004.
For programs of concern to NAMI - at both NIMH and CMHS - there are some modest increases in both the House and Senate bills. For biomedical research, both bills include small increases for the National Institutes of Health (NIH) – up to $27.67 billion in the House bill and $27.xx in the Senate bill. This is in contrast to the double-digit percentage increases that NIH received over the previous five-year period (1998 to 2003) as Congress met the goal of doubling the overall NIH budget. For CMHS, both the draft House and Senate bills hold most programs at their current levels, or in some instances actually reduce funding slightly.
As Congress moves forward on the FY 2004 appropriations process, NAMI will be pressing members of Congress and the Bush Administration on a number of key funding priorities for research and services programs. Specifically, NAMI will be asking that the final version of the Labor-HHS Appropriations bill includes:
1. An increase for mental illness research at the National Institute of Mental Health (NIMH) at least equal to the overall percentage increase for the entire NIH, and
2. Targeted increases for key programs at CMHS such as the Mental Health Block Grant, services for homeless individuals with mental illness (including the PATH program and the Bush Administration's chronic homeless initiative and initiatives targeted to replication of evidence-based programs.
More details on research and services programs of concern to NAMI can be found by viewing NAMI's testimony to the House Appropriations Committee on the FY 2003 Labor-HHS-Education bill at:
As was noted above, both the House and Senate bills contain modest overall increases for NIH – roughly 2.5% when compared to FY 2003 funding. As noted above, this increase is far below the increase enacted NIH over the past five years. However, when certain one-time costs incurred in FY 2003 for NIH (including capital improvements and increased security) are factored out, the overall increase is closer to 7%. For NIMH, the Senate bill includes $1.4 billion for FY 2004, $58.9 million more than FY 2003. This is less than the $41.1 million increase included in the House bill – the same as proposed by President Bush for FY 2004 ($1.382 billion).
NAMI is extremely grateful for the leadership of Senator Arlen Specter (R-PA) and Tom Harkin (D-IA) in pushing for an increase for NIMH that is above President Bush's request. At the same time, it needs to be recognized that holding increases for medical research in 2004 to 3% to 4%, as recommended in both the House and Senate bills, could have a devastating impact on the ability of NIMH (and NIH as a whole) to sustain the ongoing multi-year research grants that have been initiated over the past 2-3 years. This is especially the case with new research grants that have been initiated in conjunction with NIMH's new research plan on mood disorders (including new research underway on bipolar disorder).
The House version of the FY 2004 Labor-HHS-Education Appropriations bills includes a modest $7 million increase in overall funding for the Center for Mental Health Services (part of the Substance Abuse and Mental Health Services Administration, SAMHSA). By contrast, the Senate bill actually cuts CMHS funding by $1.3 million, to $855.7 million. Within specific categorical programs at CMHS, there are slight differences between the House, the Senate and President Bush's request for FY 2004. Below is a summary of funding levels for selected programs of concern to children and adults with severe mental illnesses and their families:
1) Mental Health Block Grant – Both the House and Senate bills propose to cut Mental Health Block Grant (a state formula grant program financing services for adults with severe mental illnesses and children with severe emotional disturbances) below its current $440 million level. Specifically, the House funds the Block Grant (also known as the Mental Health Performance Partnership) at $435 million and the Senate at $437 million. For FY 2004, the President requested $433 million.
2) PATH – The House bill fully funds the increase for the PATH program requested by President Bush – up from its current level of $43.5 million, to $50.1 million. The Senate recommends $47.1 million for PATH. PATH is a state formula grant program that funds community-based services for homeless individuals with mental illness. This increase is part of the Bush Administration's "Samaritan Initiative" to end chronic homelessness over the next decade. Neither the House nor the Senate bill includes FY 2004 funding for a separate initiative that NAMI is supporting for services in permanent supportive housing for chronically homeless individuals with mental illness and co-occurring substance abuse disorders.
3) Programs of Regional and National Significance (PRNS) – Both the House and Senate bills include reductions for the PRNS account for FY 2004. The Senate bill funds PRNS at $238 million ($6.5 million below FY 2003) and the House bill at $237 million. However, both these levels are above the Bush Administration's request of $211.8 million. PRNS is the discretionary budget for CMHS, i.e. funds under federal control of CMHS, as opposed to the Mental Health Block Grant and PATH that are formula grant programs to the states. Both the House and Senate bills contain directives to SAMHSA and CMHS on allocation of individual priorities within the PRNS account. For example, both bills require continuation of CMHS jail diversion program (the House bill actually increases funding for the program by $1 million, to $7 million). This Jail Diversion program funds treatment and community supports to non-violent criminal offenders with severe mental illnesses. NAMI strongly supports this program as an essential companion to the new federal Mental Health Courts program at the Justice Department and in important potential resource in addressing the growing and very disturbing trend of "criminalization" of mental illness. Both bills also include continuation of the childrens PTSD initiative at $30 million. Also, the House bill continues the $5 million for mental health services in senior centers, while the Senate bill mandates $2 million for continuation of agency-funded community technical assistance centers.
4) Childrens Mental Health – The House bill includes the Bush Administration's request for a $10 million increase for the CMHS Childrens Mental Health program, up to $108 million. The Senate proposes a freeze at $98 million.
5) PAIMI – The Senate bill proposes to increase funding for the PAIMI (protection and advocacy) program by $2 million over FY 2003, up to $35.8 million. The House bill includes $34 million, while the Bush Administration requested $32.5 million
House Bill Adds Funding for Bush Administration Substance Abuse Treatment Initiative
The House version of the FY 2004 Labor-HHS-Education bill adds an additional $100 million for the Center for Substance Abuse Treatment at SAMHSA for President Bush's "Access to Recovery" initiative. This proposal is part of the Bush Administration's effort to expand the capacity of the public sector substance abuse treatment system and promote greater consumer choice. The program would be administered directly by CSAT, separate from the Substance Abuse Treatment and Prevention (SAPT) Block Grant and the current infrastructure of state substance abuse authorities. Instead, funding for chemical dependency treatment under the President's proposal would flow through a voucher system and would promote greater involvement of faith-based providers. The House bill also increases the by $20.6 million, up to $1.774 billion. By contrast, the Senate bill does not include funding for the "Access to Recovery" proposal. However, the Senate bill does increase the SAPT Block grant by $46.1 million over the current levels, up to $1.8 billion.
House Clear Association Health Plan Measure
By a vote of 262-162, the House of Representatives passed legislation to vastly expand use of Association Health Plans (AHPs). This legislation (HR 660) would severely undermine the effectiveness of laws in 34 states that require health plans to cover treatment for mental illness on the same terms and conditions as all other illnesses (insurance parity). The legislation would allow such AHPs to organize under the federal ERISA law and exempt themselves from state regulation – including state parity laws, minimum coverage requirements and other consumer protections. NAMI opposes HR 660, concerns regarding this legislation were included in a June 16 E-News message. While a companion measure to HR 660 does exist (S 545), Senate support for AHPs is not nearly as strong as it is in the House. Nevertheless, NAMI will be pressing hard to ensure that the measure does not move forward in the absence of a requirement for ERISA self-insured to comply with a standard for parity level coverage.