CAPITOL HIL UPDATE:
Historic Movement
Toward Ending Discrimination

2008 Annual Conference Hill Day Leads to Legislative Gains

While upcoming elections tend to rivet one's focus to a new administration and a new Congress, important unfinished business still lies at the door of the 110th Congress, which has already achieved historic mental health milestones.

MHA has long emphasized that mental health is integral to overall health, and advocated that we must eliminate discrimination in mental health coverage and practice to ensure needed access to mental health care. This year, Congress took a historic step toward advancing those principles–and achieving a longtime advocacy goal in Medicare–by adopting legislation that will phase out the 50 percent Medicare co-insurance rate for outpatient mental health care.

The provision, included in the "Medicare Improvements for Patients and Providers Act of 2008”, will phase out the higher co-insurance over a six year period. The phase-out begins in 2010 when the co-insurance rate for beneficiaries is reduced to 45 percent. In 2012 it will be reduced further to 40 percent, then 35 percent in 2013. Finally, in 2014 it will be 20 percent, just as is required for other outpatient services under Medicare.

The Medicare legislation also includes provisions to improve Medicare Part D, the prescription drug benefit. One aims to strengthen the administrative policy that has required Part D plans to cover almost all medications in six key drug classes, including anti-psychotics, anti-depressants, and anti-convulsants. Another provision that MHA advocated will allow Part D plans to cover benzodiazepines and barbiturates.

Even as adjournment looms, there is further movement toward ending discrimination affecting people with or at risk of mental illness and MHA’s longsought goal of winning comprehensive mental health parity law remains within reach. Earlier in the year, congressional negotiators had reached agreement on a compromise bridging policy differences between the Senate and Housepassed parity bills. That compromise would close major loopholes in current law, and has been widely hailed by advocacy groups in the mental health and addiction communities and other long-time parity supporters, as well as by business and insurance associations. Lawmakers have found greater challenge in reaching agreement on provisions to offset the potential impact on federal revenues, but national advocacy efforts, including a recent national Pass-Parity-Now call-in day and a major Capitol Hill parity rally on September 17, have helped keep parity a legislative priority, and underscored the enormous costs of not enacting parity. Among the speakers at September’s parity rally was MHA Board member and consumer advocate Marley Prunty- Lara, who–standing by House parity sponsors Patrick Kennedy and Jim Ramstad, David Wellstone, and other parity champions–shared her own story.

As House and Senate leaders move closer to passing parity, both chambers overwhelmingly approved amendments to the Americans with Disabilities Act (ADA) that would reverse decisions of the Supreme Court and lower courts that have had the effect of limiting those who could gain ADA protection against discrimination. Among its reforms, the ADA amendments (S. 3406) clarify that Congress intended this law to be interpreted broadly, and establish that people do not lose ADA protection simply because their health condition is treatable or can otherwise be mitigated, or because their impairments are episodic. The amendments would remedy the dilemma facing people who are deemed ineligible for ADA protection because medication rendered them no longer disabled.

As the 110th Congress heads to adjournment, it will undoubtedly leave unfinished business behind, but its work on mental health issues in areas ranging from juvenile justice to SAMHSA reauthorization leaves a powerful record on which the next Congress can build.