Current Federal Policy Environment 2012 as a status quo election Continued legislative gridlock Major focus on oversight and congressional investigations – including federal involvement in mental health services – House Energy & Commerce oversight hearings – GAO investigation Newtown response – Senate HELP package (S 689) – 95-2 Senate vote on April 18

Grand Budget Deal? Federal deficit is falling – CBO now projects it to $642 billion for 2013 v. a $1.2 trillion projection earlier this year – Higher revenue projections – Fannie/Freddie returns – Lower projected health care costs Pressure for a large deficit reduction agreement is diminishing Debt limit will not be reached until at least October

FY 2014 Funding for Mental Illness Research and Services Tight limits on Non-Defense Discretionary (NDD) spending remain in place Senate FY 2014 budget resolution allows for $91 billion more in discretionary funding than the House budget resolution - $1.058 trillion v. $967 billion ($17 billion less than FY 2013 cap) NDD as percentage of federal spending is now below 1963 levels More information at

FY 2014 Funding for Mental Illness Research and Services House budget resolution protects defense and security spending and imposes a 19% reduction on NDD below the FY 2013 post-sequestration level and 28% below FY 2010 levels Senate NDD levels are much better and undo the FY % across-the-board sequestration cuts In the absence of a grand budget agreement, a “continuing resolution” at FY 2013 post- sequestration levels is expected

FY 2014 Funding for Mental Illness Research and Services NIMH FY 2014 request - $1.466 billion ($12 billion below FY 2012 with transfer to NIAID) FY 2013 sequester is resulting in 4% reductions to currently funded projects and the NIMH intramural program 529 “new and competing” grants projected for 2013 v. 584 in 2012 and fewer than 500 in 2011

FY 2014 Funding for Mental Illness Research and Services SAMHSA FY 2013 sequestration wiped out the increases Congress enacted to the Mental Health Block Grant in 2011 & 2012 that had boosted funding to $460 million FY 2013 post-sequestration levels – PATH - $62.8 million – Childrens MH - $111.2 million – Primary-BH Integration - $31.8 million – Suicide Prevention - $46 million

FY 2014 Funding for Supportive Housing HUD Section President’s FY 2014 budget seeks a $39 million reduction to the 811 Project-Based Rental Assistance (PRA) Demonstration – Cutting funding from $165 million in FY 2012 to $126 million – 811 produced over 3,500 new units of PSH in 2012 v. 948 units in 2010 & 2011 combined McKinney-Vento - President’s FY 2014 budget does request a $352 million increase for homeless assistance programs, up to $2.38 billion VASH – House, Senate and President are all in agreement in support of an $75 million for an additional 10,000 VASH vouchers for FY 2014 – supportive housing for homeless veterans

FY 2014 & FY 2015 Funding for Veterans Programs Overall Veterans Medical Care – Forward funded and NOT subject to overall limits on discretionary spending FY $ billion v. FY 2014 enacted -- $ billion FY 2015 advance appropriation included in House bill -- $ billion, a 3.4% increase over FY 2014 Veterans Mental Health Care FY 2015 advance request of $7.717 billion or a 7% increase over the FY 2014 level (a $506.3 million increase) $20 million increase in the House bill for suicide prevention activities Homelessness Activities House bill allocates $1 billion through FY 2015, in addition to $5.216 billion currently available to the VA in FY 2013 and 2014 for the non-HUD portion of VASH, the per diem program and the VA domiciliary programs VA Medical Research - President’s FY 2014 request of $585.7 million, or $3.573 million above the FY 2013 level of $ million

NAMI’s Federal Legislative Agenda Excellence in Mental Health Act (S 264 & HR 1263) - Senators Stabenow and Blunt and Representatives Matsui and Lance – would create a new, voluntary pathway for community mental health organizations to become Federally Qualified Community Behavioral Health Centers (FQCBHCs) with new requirements for reporting, standards of care and create a bundled per-visit rate that shares risk with the federal government. Examining America's Mental Health Services Act of 2013 (HR 1615) - Representatives McKinley and Kaptur – Directs the Secretary of HHS to have the Institute of Medicine conduct a study gaps in public mental health services, barriers to treatment for individuals living with serious mental illness and the availability of effective interventions. Mental Health First Aid (S 153 & HR 274) – Senator Begich and Representative Barber - Authorizes $20 million for Mental Health First Aid – a public education program that helps people identify, understand, and respond to signs of mental illness.

NAMI’s Federal Legislative Agenda Justice and Mental Health Collaboration Act (S 162 & HR 401) – Senator Franken and Representative Nugent – Would extend the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA) and continue support for mental health courts and crisis intervention teams and authorize veterans’ treatment courts and provide transitional services to reduce recidivism rates and expand screening practices that identify inmates living with mental illness. Mental Health in Schools Act (HR 628 & S 195) – Senator Franken and Representative Napolitano – Authorizes funding to increase the availability of comprehensive school-based mental health services and supports and to build effective links between schools and the community mental health system. Keeping All Students Safe Act (HR 1893) – Representative Miller – Would restrict the ability of schools to use restraint and seclusion with children.

Federal Parity Regulations Expected Soon Compliance with requirements for equitable coverage for durational treatment limits and financial limitations not at issue Clarity needed for parity with respect to – Non Quantitative Treatment Limitations – Scope of Services ACA requires all heath plans offered the Exchanges to comply with parity