Brain Injury Lawyer Blog

A weekly update on federal policy activity related to traumatic brain injury
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Dear Advocates:

In late breaking news from the United States Capitol, Congress has just approved a $700 billion financial bailout package, which also includes landmark mental health parity legislation (H.R. 1424/S. 558) and dozens of expiring tax breaks for businesses and individuals.

This legislation was sent in an expedited fashion this afternoon to President Bush who signed the measure into law hours after its passage.

As the previous edition of Policy Corner noted, several important legislative developments occurred last week, and this week’s edition of Policy Corner includes additional details about these developments as they pertain to brain injury policy.

It remains unclear whether Congress will return for a lame duck session in November after the elections, although at least a short session appears likely for the Senate the week of November 17. BIAA will provide an update on the remainder of this year’s congressional schedule as soon as this information available.

*Distributed by Laura Schiebelhut, BIAA Director of Government Affairs, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637; lschiebelhut@biausa.org

BIAA’s Policy Corner and Legislative Action Alerts are made possible by the Centre for Neuro Skills, James F. Humphreys & Associates, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.

To sign up to receive future BIAA Policy Corner E-Newsletters and Legislative Action Alerts, please go to http://capwiz.com/bia/mlm/signup/
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Congress Passes Financial Bailout Legislation, Mental Health Parity

In late breaking news from the United States Capitol, Congress has just approved a $700 billion financial bailout package, which also includes landmark mental health parity legislation (H.R. 1424/S. 558) and dozens of expiring tax breaks for businesses and individuals.

This marks a tremendous victory for mental health advocates and others who have supported efforts to enact a parity bill for years. This legislation will require private health insurers to offer mental health and addiction benefits equal in cost and scope to traditional medical benefits.

Earlier this year, BIAA strongly endorsed the House version of this legislation. In a letter officially endorsing the bill in March, BIAA noted, “An intricate and intertwined relationship exists between substance abuse, mental health, and traumatic brain injury (TBI). Substance use and abuse is often both an antecedent to and a consequence of TBI.”

Upon its passage this afternoon, one of the bill’s sponsors and leading champions, Congressman Patrick J. Kennedy (D-RI), stated:

“This legislation is one more step in the long civil rights struggle to ensure that all Americans have the opportunity to reach their potential. For far too long, health insurance companies have used the stigma of mental illness and substance abuse as an excuse to deny coverage for those biological disorders. That ends today when this critical legislation outlaws the discrimination that is embedded in our laws and our policies.”

Other bill sponsors and leading supporters include Rep. Jim Ramstad (R-MN) in the House of Representatives, as well as Sen. Pete Domenici (R-NM) and Sen. Edward Kennedy (D-MA) in the Senate. Late Senator Paul Wellstone (D-Minn.) was also a leading champion of this legislation.

Appropriations Update

Last week, the House passed an omnibus continuing appropriations bill to fund most government programs – including TBI and trauma-related programs – at Fiscal 2008 (last year’s) levels until March 6, 2009.

Over the weekend, the Senate also passed this omnibus legislative package and forwarded it to President Bush, who signed it into law just hours before the beginning of the new fiscal year on October 1.

This massive year-end spending package includes a Continuing Resolution (CR) which funds programs covered by nine unfinished appropriations bills (including the Fiscal 2009 Labor-HHS-Education Appropriations bill, which contains funding for key federal TBI programs) at Fiscal 2008 levels until enactment of the bills or March 6, 2009 – whichever comes first. This essentially leaves final funding decisions on domestic programs to the next Congress and president.

Within this CR, all civilian health programs, including TBI and trauma-related programs, are funded at Fiscal 2008 levels. These Fiscal 2008 levels, and thus continuing funding levels through the beginning of next year, are as follows:

CDC TBI Programs (HHS): $5.709 million

HRSA TBI Programs (HHS) (HRSA TBI State Grant Program and Protection and Advocacy Systems): $8.754 million

TBI Model Systems of Care (NIDRR/Department of Education): $8.155 million

In addition to the CR to provide continuing appropriations for most federal programs, the omnibus bill also includes three Fiscal 2009 appropriations bills in their entirety. These three appropriations bills are those that fund Defense, Homeland Security and Military Construction-VA for all of FY 2009.

The Defense appropriations measure included in this legislative package contains $300 million in funding for Traumatic Brain Injury and Psychological Health initiatives within the Department of Defense.

The Military Construction-VA appropriations measure includes $41 billion in funding for the Veterans Health Administration (veterans medical care), representing $1.8 billion above the President’s budget request earlier this year and $4.1 billion above 2008 levels. This funding bill also provides $510 million in funding for Medical and Prosthetic Research, including cutting edge research into areas such as Post Traumatic Stress Disorder (PTSD), Traumatic Brain Injury, suicide prevention, and polytrauma. This funding level for research represents $30 million above 2008 levels, and rejects a $38 million cut proposed by President Bush.

The Military Construction-VA appropriations bill contained in this omnibus legislative package also included important report language (strongly supported by BIAA) urging the Department of Veterans Affairs to increase returning servicemembers’ access to TBI care and expertise in the civilian sector. Specifically, the Explanatory Statement accompanying this bill states:

“The Appropriations Committees strongly urge the Department to establish and expand cooperative agreements with public and private entities with neurobehavioral rehabilitation and recovery experience in the treatment of Traumatic Brain Injury (TBI) as recommended in section 1703 of Public Law 110-181” [FY 2008 National Defense Authorization Act].”

In addition, the bill provides $200 million for fee-based services intended to allow the VA to tap expertise in the public and private sector for health care that may not be readily available within VA medical centers.

Congress Authorizes VA Epilepsy Centers of Excellence

Last week, the House passed an omnibus veterans health care package (S. 2612), including key provisions of The Epilepsy Centers of Excellence Act (H.R. 2818/S. 2004), which BIAA has strongly endorsed.

Over the weekend, the Senate also passed this legislation and it is expected to be signed into law by the President imminently.

The legislation, championed by the American Academy of Neurology and endorsed by BIAA, anticipates an expected increase in the number of TBI-related epilepsy cases among veterans returning from service in Iraq and Afghanistan. The bill will create up to six Epilepsy Centers of Excellence (ECoE) at the Depart ment of Veterans’ Affairs (VA), and is aimed at restoring the VA as a national leader in epilepsy care and research.

The bill was sponsored by Rep. Ed Perlmutter (D-CO) in the House of Representatives and Sen. Patty Murray (D-WA) in the Senate.

Congress Clears FY 2009 Defense Authorization Bill For President’s Signature

Within the past few days, Congress also passed the FY 2009 defense authorization bill (S. 3001). This legislation contains a “Sense of Congress on TBI Research.” Specifically, the bill states in Sec. 725:

“It is the sense of Congress that the requirement under section 1621(c)(7) of the National Defense Authorization Act for Fiscal Year 2008 (Public Law 110–181; 122 Stat. 453; 10 U.S.C. 1071note) to conduct basic science and translational research on traumatic brain injury includes pilot programs designed to test the efficacy of clinical approaches, including the use of pharmacological agents. Congress urges continued studies of the efficacy of pharmacological agents for treatment of traumatic brain injury and supports continued joint research with the National Institutes of Health in this area.”

BIAA Signs on To Coalition Letter Opposing Proposed Medicaid Outpatient Regulation

BIAA recently signed on to a coalition letter urging Congress to enact a moratorium on a regulation proposed by the Centers for Medicare and Medicaid Services (CMS) to restrict Medicaid reimbursement for outpatient services. This regulation is termed the “Medicaid Outpatient Clinic and Hospital Services Rule,” and it would reduce federal Medicaid funding to states for freestanding health clinics and hospital outpatient departments.

This regulation, published on September 28, 2007 – and expected to be finalized in November of this year – would cut Medicaid reimbursement to many types of outpatient services, including services utilized by individuals with brain injury. [72 Federal Regulation 55158 to 55166 (to be codified at 42 C.F.R. 440, 447 and sometimes referred to as CMS 2213-P).]

To prevent finalization of this rule, BIAA has joined the Consortium for Citizens with Disabilities in urging Congress to enact a moratorium delaying implementation of this harmful regulation through April 2009.
In a heartening development, this week Members of Congress introduced legislation aimed at enacting such a moratorium.

Yesterday, Sen. Charles Schumer (D-NY) and Sen. Hillary Rodham Clinton (D-NY) introduced the “Preserving Access to Healthcare” (PATH) Act of 2008, which would, among other provisions, delay the proposed Medicaid outpatient regulation by six months.

In addition, earlier this week, Rep. John McHugh (R-NY) introduced H.R. 7219, the Protecting Hospital Outpatient and Community Clinic Services Act of 2008, which would provide a moratorium on the regulation.

BIAA strongly supports these legislative efforts.

BIAA Representatives Attend Trauma Spectrum Disorders Conference

Multiple BIAA representatives attended this week a scientific conference titled, “Trauma Spectrum Disorders: The Role of Gender, Race & Other Socioeconomic Factors.”

This conference – jointly sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, the Department of Veterans Affairs, and the National Institutes of Health – focused on identifying and sharing knowledge and lessons learned about gender and race as they relate to psychological health and traumatic brain injury.

Presentations made at this conference are expected to soon be made publicly available on the Defense Center of Excellence’s website: http://www.dcoe.health.mil/.