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Independent Living News & Policy from the National Council on Independent Living

An Update from the NCIL Mental Health Civil Rights Subcommittee

The NCIL Mental Health Civil Rights Subcommittee has been actively working on mental health legislation. We have also been monitoring some regulatory developments. Tim Murphy’s bill, H.R. 2646, is still a priority. However, we are seeing promising action in the Senate and could use your help. Please contact your Representative and Senators.

The biggest priority is the Senate. Prior to the spring recess, the Health, Education, Labor and Pensions Committee marked up S. 2680. This bill is a truly bipartisan compromise. We expect the Senate to take it up soon after they return next week.

NCIL supports S. 2680 because it reauthorizes mental health and substance use programs without the baggage in the House bill. It approaches key issues differently:

  • Like the House bill, it also creates a new assistant secretary position.
    • It does not include most of the other objectionable reorganization provisions included in the House bill.
  • It approaches the health privacy issues with training and guidance requirements rather than writing discrimination into the law.
  • As NCIL and others recommend, it does not change the “IMD Exclusion.”
    • The IMD (“Institutions for Mental Disease”) Exclusion has been a part of Medicaid since the program was created. It does not allow federal payments for mental health or substance use treatment for people older than 22 and younger than 65 in a facility with 16 or more beds treating primarily people with psychiatric conditions. IMDs are mostly hospitals and nursing facilities.
    • However, several committee members have indicated they would make a floor amendment to change the IMD rule.
  • It does not change existing law on involuntary services or protection and advocacy systems.

S. 2680 does not include all of the policy that NCIL and others support. While not a perfect bill, we believe it sets a much better approach than the House approach. Please contact your Senators to ask them to support the bill without further amendment regarding IMDs. 

Of course, H.R. 2646 is still pending in the House Energy and Commerce Committee. The bill has gained a few co-sponsors since the Health Subcommittee marked up the bill in November. However, the Committee leadership has been trying to resolve a number of disagreements regarding the bill. Still, there is significant pressure to move the bill. As you know, the big issues for NCIL on H.R. 2646 are that it:

  • Requires discrimination against people based on disability in health care and education privacy (allows doctors to disclose information to “caretakers” under circumstances not allowed for people without psychiatric disability – called “serious mental illness” in the bill);
  • Promotes institutional services by modifying the Medicaid “IMD Exclusion;”
  • Promotes involuntary outpatient treatment through state block grant incentives;
  • Restricts the ability of P&As to represent consumers; and
  • Unnecessarily reorganizes the Substance Abuse and Mental Health Services Administration to increase the role of doctors in administration and policy at the expense of consumers and other stakeholders.

Rep. Upton (R-MI), the Chairperson, and Rep. Pallone (D-NJ), the Ranking Member, need to hear from us. Read a recent sample letter from the National Disability Leadership Alliance that addresses current issues and includes their office addresses.

The Message:

  • Please let them know of our concerns and ask them not to move HR 2646 unless amended in a truly bipartisan manner.
    • Suggest S. 2680 as an example of what that might look like.
  • Please also contact your Representatives with similar information and send a copy to mikeb at

Please contact Mike Bachhuber, Chairperson, or the NCIL office for more information or assistance on where to send your letters.