Congress Expands Jail/Prison Grant Programs
Momentum is picking up in Congress to expand the frontline federal grant program that provides money to local prisons and jails for handling of nonviolent offenders who have mental health problems. However, while an effort is afoot to expand the authorization for the Justice and Mental Health Collaboration Program run by the Justice Department's Bureau of Justice Assistance (BJA) since 2004, Congress's support for the program, based on past appropriations, is likely to remain slight.
The House Judiciary Committee passed a bill (HR 3992) on November 7 by a voice vote—meaning it was noncontroversial—that raises the amount of money (the authorization level) Congress can appropriate each year for the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA) grant program. The authorization was increased from $50 million to $75 million. Rep Bobby Scott (D, Va) is the sponsor of the bill in the House.
However, Congress has not come close to appropriating enough since the grant program was established in 2004. The appropriation was $5 million in both 2006 and in 2007. That figure is expected to increase to $10 million in 2008, according to Fred C. Osher, MD, a psychiatrist and director of health systems and services policy, Justice Center at the Council of State Governments, a nonprofit agency that helps the BJA run the grant program.
That MIOTCRA awards grants in 3 categories. Planning grants are given for 12 months up to a maximum of $50,000. Planning and implementation grants can run $250,000 for 30 months. Implementation and expansion grants run $200,000 for 24 months. A minimum of 20% local match is required in all 3 categories. The grants allow cities and counties to provide early intervention for system-involved offenders with mental illness; provide new and existing mental health courts with various treatment options; maximize diversion opportunities for nonviolent offenders with mental illness and co-occurring disorders; and promote training for justice and treatment professionals on criminal justice processes and mental health and substance abuse issues. The BJA awarded 26 grants in 2006 and 27 grants in 2007. But the number of grants awarded was only 11% of the total grants applied for.
The bill the Judiciary Committee passed is called the Mentally Ill Offender Treatment and Crime Reduction Reauthorization and Improvement Act of 2007. The Senate companion bill (S 2304) was introduced by Senators Pete Domenici (R, NM) and Edward Kennedy (D, Mass) 2 days before the House committee vote. In addition to reauthorizing the Justice and Mental Health Collaboration Program at $75 million, the bill also creates a number of new grant programs, each with an authorization, and mandates a study—authorized at $2 million—that would allow the BJA, for the first time in 15 years, to do an epidemiological study of mental illness among jail and prison populations.
Data on this subject are sorely lacking, according to Osher, who says the last time anyone did a good study was 20 years ago when Linda Teplin did her pioneering work in Cook County, Illinois. Teplin is professor of psychiatry and director of the psycho-legal studies program at Northwestern University Medical School, Chicago.
On the floor of the Senate in November, when he introduced his version of the bill, Kennedy alluded to Bureau of Justice statistics showing that more than half of all prison and jail inmates had a mental health problem in 2005, including 56% of inmates in state prisons, 45% of federal prisoners, and 64% of jail inmates. But Osher says the survey form the Bureau of Justice used asked for evidence of "mental problems" as opposed to "mental illness." He adds, "You wouldn't hang your hat on those numbers as evidence of the prevalence of mental illness in those settings." Teplin's numbers were much lower.
However, Osher explains that prevalence is less the issue than the fact that 3 to 5 times as many men incarcerated in jail and prison settings have mental illness compared with the general population. For women, it is 5 to 8 times.
For example, one of the new grant programs in the bill would allow governments to actually provide mental health treatment to offenders. The bill also addresses the statutorily separate issue of mental health courts, which Congress established in 2000 as part of a bill called America's Law Enforcement and Mental Health Project. From 2002 to 2005, Congress appropriated $7.4 million for mental health courts: $4 million in 2002, $3 million in 2003, and $400,000 in 2005. No money has been appropriated for the past 2 years nor is any in the cards for fiscal 2008.
Mental health courts can apply to the Justice and Mental Health Collaboration Program for grants; some courts have received federal funding that way in the past few years. The MIOTCRA bill reauthorizes the separate mental health courts program through 2013 at $10 million per year. But again, appropriations will be an issue.
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Congress Moves to Avert Medicare Cuts for 2008
Congress looks as though it will avert scheduled cuts in Medicare payments to physicians for 2008, which is good news for psychiatrists who were scheduled to see average payments for office visits decline 10%. Sen Max Baucus (D, Mont) planned to bring a bill to the Senate floor in December that would erase the scheduled negative fee update for calendar 2008, which Medicare was forced to impose because of a congressionally mandated formula. The House had previously approved a bill that eliminated the 10% negative update in 2008 and an anticipated 15% negative update in 2009 in favor of 0.5% increases in each of those 2 years.
As this is being written, it is not clear whether the Senate will vote to simply freeze the conversion factor in 2008, as Congress did at the last moment in 2006 for 2007, or agree to the House's 0.5% positive update. Some Senate Republicans were unenthusiastic about going along with the House's increase to the update because the House cut reimbursements to Medicare health plans to pay for the physician pay increase. The update is the dollar figure that is multiplied against the total relative value units for each CPT code to get the Medicare fee for that procedure.
Although Congress will erase the negative 10% update, it will let stand Medicare's sequestering of $1.35 billion in a Physician Quality Reporting Initiative bonus fund. Physicians who report specific measures on quality of care furnished to Medicare beneficiaries may earn incentives up to 1.5% of their total allowed charges, subject to a cap. These structural measures focus on whether a physician uses electronic health records and/or electronic prescribing.