by Linda R. Wolf Jones, D.S.W.
TCA Executive Director

In the Winter ’99 issue of this newsletter, I made a number of predictions about legislative proposals that I anticipated would reappear on the congressional agenda in 1999. Legislative proposals in that category included consumer protections and patients’ bills of rights, substance abuse parity, and Substance Abuse and Mental Health Services Administration (SAMHSA) reauthorization. With respect to the FY ’00 appropriations process, I also suggested that prevention and treatment advocates would be concerned about the prospects for holding onto the broad-based FY ’99 appropriations increases for substance abuse programs. Where are we now, a few months down the road, on these issues?

Consumer Protections
As predicted, consumer protection bills quickly reappeared as a top health care agenda item for the 106^th Congress. The bill that is currently moving (S. 326) was introduced by Senator Jeffords (R-VT) at the end of January and referred to the Committee on Health, Education, Labor and Pensions. That committee, which is chaired by Senator Jeffords, passed the bill in mid March and sent it to the full Senate for consideration.

There will undoubtedly be changes in the bill as it continues through the legislative process in both houses of Congress. At this point, it appears likely that if enacted, the legislation will contain provisions governing the confidentiality of records and the right of the consumer to be told about all treatment options, but will not specify that doctors (rather than health insurers) would be the definers of "medical necessity."

Parity
Substance abuse parity was a hot issue in the 105^th Congress under the leadership of Senator Wellstone (D-MN) and Representative Ramstad (R-MN), but no stand-alone substance abuse parity bills have been introduced so far this year.

It now appears that if a substance abuse parity bill is introduced, it would contain treatment limitations that were not found in the bills introduced in the 105^th Congress. If that were to happen, the bill would probably not command the unified support of the substance abuse community.

Senator Domenici (R-NM), who is a strong advocate of mental health parity, introduced a bill in mid-April that would strengthen health insurance coverage for mental illnesses. That bill, however, only addresses coverage for severe biologically based mental illnesses and mental health benefits generally. Substance abuse treatment is not included among its provisions.

Also in April, a bill covering mental health and substance abuse benefits was introduced by Representative Roukema (R-NJ) with 22 co-sponsors.

SAMHSA Reauthorization
SAMHSA reauthorization got off to a rockier start this year than anticipated. Several controversial issues surfaced, dividing the substance abuse community and putting it at odds with the mental health community. Questions dealing with mandated state planning/advisory councils, special conditions for religious-based treatment programs ("charitable choice"), and blending of block grant funds for the treatment of co-occurring disorders have all been the subject of discussions over the past few months. Senators Frist (R-TN) and Kennedy (D-MA) introduced a reauthorization bill in May, which they hope will pass the Senate by the August recess period.

The bill includes provisions for the repeal of a number of the set-asides in the substance abuse block grant, such as the requirements that states spend 35 percent of their allotment on alcohol related activities and 35 percent on drug related activities and that they maintain a revolving fund of $100,000 to support group homes. It also allows states to request a waiver from other program requirements that must currently be met for receipt of block grant funds in an effort to give states greater flexibility in their use of the funds.

Growing time pressures in Congress have diminished the chance of passage for many of this year’s pending legislative items. Given the potential controversies surrounding and complicating the SAMHSA reauthorization bill, it remains questionable whether we will see its enactment this year.

FY ’00 Appropriations
As I suggested in the Winter newsletter, the ups and downs of Federal funding levels for substance abuse prevention, treatment and research programs are frequently unpredictable.

The Administration’s proposals for FY ’00 contain both positives and negatives. The President’s budget recommends a $30 million increase for the substance abuse block grant, $55 million increase for the Center for Substance Abuse Treatment (CSAT), $26 million decrease for the Center for Substance Abuse Prevention (CSAP), and $15 million increase for the National Institute on Drug Abuse (NIDA).

Advocates from the substance abuse community are calling for substantially larger, across-the-board increases over FY ’99 funding levels – including a $300 million block grant increase, $83 million CSAT increase, $91 million CSAP increase ($88 million plus a $3 million increase for CSAP’s High Risk Youth Grants) and $162 million increase for NIDA.

While substance abuse advocates are supporting higher funding levels to help address the gap between needs and services, there is also a recognition that FY ’00 funds will be tight and demands on them competitive. The entire substance abuse community is called upon to speak out for these programs.