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Children's Needs Focus of 2 Health Hearings

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Washington

In spirited testimony before two Congressional committees last week, children's advocates appealed to lawmakers to consider the special needs of children with mental illness and disabilities as they set to work on health-care reform.

Mental-health services for children are rarely covered as generously as other medical procedures, Dr. Carolyn Robinowitz, the senior deputy medical director of the American Psychiatric Association, told the House Subcommittee on Labor-Management Relations.

Only two of the major health-care-reform plans under consideration--President Clinton's and the "single payer'' plan--explicitly mention mental-health services for children.

Dr. Robinowitz was also dissatisfied with the Clinton plan's restrictions on hospital stays for severely disturbed children. Psychiatric hospital stays would be limited to 30 days, she said, while other medical treatments are unlimited.

Panelists were also apprehensive that Medicaid benefits would be phased out before new health-care benefits are in place.

"If Medicaid is restricted, and we are back in the outpatient days, it's going to be scary,'' Randall Feltman, the director of the Ventura County, Calif., mental-health department, said.

Mr. Feltman decried the plans' lack of explicit coverage for alternative-care facilities for children. A flexible community-based system of care would be less expensive than hospitalization and would allow children to stay in school, he argued.

Rep. George Miller, D-Calif., who chaired the hearing, took the opportunity to criticize the Administration's proposed "health security act'' and tout the single-payer plan.

"The President's plan restricts how you can use the dollars and doesn't address the needs of families with mental illness,'' said Mr. Miller, promising to introduce an amendment to the single-payer bill that would expand mental-health services for children at school- and community-based centers.

Benefits for Disabled Children

Home- and community-based long-term-care benefits also garnered attention last week at a hearing of the Senate Labor and Human Resources Committee on the effects of the Administration's plan on individuals with disabilities.

Sen. Edward M. Kennedy, D-Mass., the committee chairman, first raised the issue in a question to Judith Feder, a Department of Health and Human Services official who has been working on health-care reform.

Mr. Kennedy expressed concern that the Clinton bill lacks sufficient home-care coverage.

"That benefit,'' Ms. Feder said, "is, consistent with health-care [benefits] today, a limited benefit.''

"But we're working on it,'' she said.

Sen. Tom Harkin, D-Iowa, reiterated a concern that has been echoing throughout the special-education community.

Senator Harkin told Ms. Feder that he remained unsure whether the benefits Medicaid-eligible children now enjoy under the Early and Periodic Screening, Diagnosis, and Treatment Services program--a funding source for medically related special-education services--would be covered under the Clinton plan, and vowed to protect those benefits. (See Education Week, Nov. 24, 1993.)

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