Mental Health Association in New York State, Inc.
(Publication Archives)

Friday Fax from Albany

New York to Pataki: Don’t do Preferred Drug List: MHANYS' campaign to stop a Preferred Drug List and Prior Authorization in this state was aided this week by two major new developments. First came the release of a Zogby Poll showing overwhelming opposition to the idea of placing medical decisions in the hands of government officials. The second development was a new study by the Kaiser Family Foundation’s Commission on Mediciad and the Uninsured, which found that little research has been done to determine the effects of Preferred Drug Programs and Prior Authorization on Medicaid recipients. MHANYS used both of these events to issue a press release Thursday against the Governor’s proposed PDP.

Text of the press release

Study, Poll Show No Basis or Support For Governor’s
Proposed Prescription Drug Program

The governor’s proposed Medicaid prescription drug program lacks public support and empirical basis, according to a recent poll by Zogby International and a study issued by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.

A poll recently conducted by Zogby International showed that New Yorkers overwhelmingly rejected a proposal to give the NYS Department of Health (DOH) control over which medications individuals on Medicaid can receive. 82% of New Yorkers were opposed to the concept of taking medical decisions away from doctors and putting them in the hands of government officials. 80% of New Yorkers continued to oppose this idea even after it was made clear that the limitations would apply only to those on Medicaid. The poll, which showed similar results regardless of age, race, political affiliation, religion, and region of the state, has a sampling error of +/- 3.8%.

A report issued this week by the Kaiser Commission on Medicaid and the Uninsured has stated that while many states are rushing to implement Preferred Drug Programs (PDP), little is known about the effects that these programs have on Medicaid recipients and providers. The Kaiser report focused on programs that currently exist in California, Georgia, Oklahoma, Oregon, and Washington. The report finds that “There appears to be little monitoring of the effects of prior authorization on beneficiaries and providers at the state level.” The report goes on to state that the programs that have the least controversy amongst providers and beneficiaries are those viewed as having the most credibility by all stakeholders.

“It is not much of a surprise to me that New Yorkers, who take pride in the fact that our state has one of the strongest healthcare systems in the country, overwhelmingly oppose this unproven program,” says Joseph Glazer, President and CEO of the Mental Health Association in New York State. “The Preferred Drug Program would risk the well-being of millions of New Yorkers without any empirical evidence pointing to its efficacy, which is tantamount to medical experimentation on the poor and most vulnerable of our citizens.”

According to Glazer, a similar plan implemented by Florida has indirectly resulted in the deaths of two people, one who was living with mental illness and the other who died as a result of a complication of heart disease.

"Persons with mental illness and their families know firsthand how important it is to have unimpeded access to medications,” said J. David Seay, Executive Director of the National Alliance for the Mentally Ill of New York State (NAMI-NYS). “Lack of access to psychiatric medications can quickly unravel, and destroy, lives. Efforts to control Medicaid costs by impeding access to medications are bad medicine and social policy."

“These programs purportedly save money, but as the Kaiser report shows, nobody has yet looked at the cost to recipients,” says Glazer. “Nobody wants to ask the difficult questions that go along with these programs, such as are they resulting in an increase in emergency room visits, institutional care, or even jail time? Nobody knows, because nobody has bothered to look at the social costs.”

A number of groups, including those representing individuals living with mental illness, heart conditions, Alzheimer’s Disease, Asthma, Diabetes, Cerebral Palsy, and other chronic conditions are working together to oppose the Governor’s proposed PDP. They have sent a letter detailing their concerns to the NYS Department of Health.

Note: For more information on the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured report, entitled Prior Authorization for Medicaid Prescription Drugs in Five States: Lessons for Policy Makers, go to http://www.kff.org/content/2003/4094/

Online Advocacy Campaigns Gain Steam, Still Need More: Both of MHANYS’ online advocacy campaigns are showing Legislators that there is strong public support for our positions. However, as we move into what could very well be the defining week of the Legislative Session, it is more important than ever to make sure that you make your voice heard. If you have not yet sent your legislators an e-mail using our Online Advocacy system, please take a few moments right now to do so. We cannot pass Timothy’s Law and prevent the Governor from limiting access to medications without a strong show of support from you. Please visit the MHANYS online advocacy system at www.mhanys.org.

Children’s Mental Health Week: Children's Mental Health Week is nearing. What are you doing to help raise awareness to the importance of this issue? See the Children's Mental Health Toolkit online. Make things happen in your home town.

May 4th - 10th is Children's Mental Health Week.

In The News:
Hutchings closing seen as inevitable; Mental health advocates admit it's likely, want savings used for programs
Syracuse Post Standard, April 21, 2003

While Central New York's politicians are solidly against Gov. George Pataki's plan to close Hutchings Psychiatric Center, some mental health advocates say it may not be a bad idea and concede closing or downsizing it is probably inevitable.

But those advocates also emphasize that the state must "reinvest" the savings from closing Hutchings into other mental health services for Central New York.

Shirley Tindall, a consumer of mental health services, says she'd have no problem with the Syracuse facility closing - with that condition.

"If it can be guaranteed the money (savings) is reinvested in our community, then I'm all for it," Tindall, 54, of Syracuse, said on the steps of the state Capitol last week after she and about two dozen other Central New Yorkers participated in a rally supporting "reinvestment."

Tindall, who said she has not used services at Hutchings, isn't alone. Two powerful advocacy groups for the mentally ill - the New York Association of Psychiatric Rehabilitation Services, or NYAPRS, and the Mental Health Association in New York State - are not opposed to closing Hutchings and several other psychiatric centers around the state.

And the chairman of the state Senate's Mental Health and Developmental Disabilities Committee called the downsizing and possible closing of Upstate psychiatric hospitals inevitable.

But all argue the savings from any closings should be reinvested in the community, and NYAPRS says patients in a hospital that closes should have the chance to remain in their community "with an appropriate array of 'step down' community housing, services and supports."

Pataki's plan calls for shutting Hutchings by July and transferring inpatients and staff to Utica's Mohawk Valley Psychiatric Center.

The Pataki administration says the closing of three Upstate centers - Hutchings, Elmira and Middletown - would save the state $18.2 million a year in the midst of a fiscal crisis. Closing Hutchings is expected to save $6.6 million.

But even Republican allies of Pataki say his plan is ill-advised.

"We're trying to preserve the psychiatric centers and come back with a reasonable plan that downsizes facilities over time," said Sen. Thomas Libous, R-Binghamton, the mental health committee chairman. "Ultimately, there is going to be downsizing. But the way it's proposed by the Division of the Budget is unacceptable." Libous suggested parts of Hutchings could eventually be converted into transitional housing units, with the psychiatric center becoming apartment-type living units.

"It would keep people employed; you keep up the facility," Libous said. "There are all types of options. The problem with (Pataki's budget) proposal is they give us no options."

Libous' Assembly counterpart wasn't as convinced of the inevitability of downsizing. "We haven't had the right type of planning for the state of New York so we can make the intelligent decisions - how many beds do we need, and if we do close beds, how do we properly close them?" said Assemblyman Peter Rivera, D-Bronx. He said he wants a council for long-term mental health planning.

"I'm not ready to answer what the rock-bottom number of (psychiatric hospital) beds should be," said Rivera, the new chairman of the Assembly Mental Health Committee.

"Until I know that, I can't say we're ready to close."

About 4,200 New Yorkers remain in psychiatric institutions, down from about 90,000 in the 1950s.

But Rivera and Libous do agree on "reinvestment."

A law requiring savings from institutional downsizings to be invested in local communities expired in 2001, and Libous last week introduced a bill to match one proposed earlier by Rivera to reinstate the law.

Pataki vetoed a similar bill last year.

And the Pataki administration says the $11.5 billion deficit the state has to close in the current fiscal year, which began April 1, makes the new reinvestment bill ill-advised.

"The current fiscal crisis precludes new reinvestment funds for fiscal year 2003-04," state mental health Commissioner James Stone told lawmakers during hearings on Pataki's $90.8 billion budget proposal earlier this year. "Instead, savings would be used to preserve the existing system" and to pay for cost-of-living increases for community mental health workers and an increase in the fee the state pays for certain Medicaid mental health services.

Stone spokesman Roger Klingman noted last week Pataki has proposed creating 600 supported mental health housing beds, although that project wouldn't begin until 2004-05.

Klingman said New York's psychiatric hospital infrastructure is excessive.

"New York's adult, inpatient psychiatric system, with 17 facilities, is the largest in the nation by far," said Klingman, noting California has just four psychiatric hospitals.

"Many of those (New York) psychiatric centers have space that is not being fully used. Others require structural improvements and updates that will cost millions of dollars."

Still, the sense is the budget state lawmakers plan to adopt this week - when they return from their Easter/Passover break - will preserve Hutchings, Middletown and Elmira psychiatric centers.

State worker unions have already obtained a court order blocking further administration moves toward closure.

Pataki is not in on budget negotiations, and there is widespread anticipation at the Capitol that he will veto any additions or changes legislators make to the budget he proposed Jan. 29.

Stress Is Up. So Why Are Mental Health Benefits Down?
New York Times, April 20, 2003

Feeling anxious or depressed? The continuing uncertainties of war, terrorism and the weak economy have left many people longing for stability and looking for ways to cope. But just when some people could arguably gain the most by spending a little time on a therapist's couch, their mental health benefits are at risk.

In a survey this month by the Pew Research Center for the People and the Press in Washington, about a third of the people questioned said they felt depressed by the war with Iraq. Russ Newman, executive director for professional practice at the American Psychological Association, said the war was affecting the vast majority of the group's patients, based on a survey conducted last month, but that it was "just the latest stressor."

"Over the years, the stress people feel just continues to increase," he said.

The share of employers offering mental health benefits, however, dropped to 76 percent last year from 84 percent in 1998, according to the 2002 benefits survey of the Society for Human Resource Management. Because health care costs are estimated to rise 15 percent this year, "employers are looking for areas where they can cut costs," said Jennifer Schramm, manager of workplace trends and forecasting for the human resources group, "and mental health is one of the areas that's easier to cut."

"People are less likely to protest because of the stigma around it," she added.

Even if they don't cut benefits outright, some employers are increasing co-payments and deductibles, said Patrick Leary, a group health care consultant at Watson Wyatt Worldwide, a human resources consulting firm based in Washington. Others are reducing out-of-network coverage, he said. That is significant because many psychologists and specialists do not participate in large health care networks.

By reducing mental health coverage, employers may be hurting themselves. In a study released in February by Mercer Human Resource Consulting and Marsh Inc., an insurance broker, 70 percent of 723 employers reported that stress or depression had increased in cost or frequency as a disability condition during 2001. That was a higher figure than for any other health problem, including cancer, lower-back pain or repetitive trauma like carpal tunnel syndrome. "Many industries have been cutting back on staff because of the economy, but the work still has to be done," said George Faulkner, a principal at Mercer. "That exacerbates the stress."

In 1996, Congress took the first step toward elevating mental health coverage to a par with medical and surgical care. It passed legislation that prevented private plans from setting lower annual or lifetime caps for mental health care than for other types of coverage. But that law allowed companies to require much higher deductibles and co-payments for mental health treatment than for other kinds of care.

A bill introduced this past winter in the House and the Senate would close those loopholes. But it's no panacea; like the original bill, it would apply only to employers who already offer mental health coverage, and then only to those with 50 or more employees. There has also been talk of restricting the disorders covered by the bill — excluding, for example, post-traumatic stress syndrome, anorexia and autism.

Of course, the bill could backfire, even with the restrictions. "I've certainly heard of employers who've said they'd drop their mental health coverage if the legislation goes through," said Ruth Donahue, a health care consultant in the Chicago office of the Segal Company, a benefits consulting firm based in New York.

Noting that employers found ways to circumvent the original 1996 legislation by requiring higher co-payments and deductibles, Ms. Donahue said, "if they put real teeth into this new parity legislation, it will be interesting to see what kind of creative ways employers find to get around it again."

And for an already anxious public, that may be just one more thing to worry about.

Strock's disorder - Letter to the Editor
Schenectady Gazette, April 24, 2003

Carl Strock should do the readers of the Gazette a favor and hie himself out of his armchair and get better informed about the topics he writes about.

In his April 10 column, "Of dogs, disorders and parity," he does an outstanding job of laying out all the outdated arguments for mental health discrimination. Mr. Strock is apparently unaware of the modern tools that insurance companies use nowadays to help prevent just the sort of chicanery he is so afraid of.

Mr. Strock's fear of mental health parity is so unfounded that it borders on paranoia. Fortunately for Mr. Strock, there is treatment available - if he is insured.

CLAIRE MAZIARCZYK
Niskayuna

Until next time, we remain,
Working to ensure available and accessible mental health services for all New Yorkers