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

Friday Fax from Albany

BUDGET DEADLINE FAST APPROACHING – PROGRESS CONTINUES: Members of the NYS Senate and Assembly continued making progress toward an agreement between the two houses this week as the April 1st budget deadline approaches at the end of next week. Using the budget conference committee process, they have negotiated amongst themselves for two weeks now, trying to find agreement on how to move forward.

Mental Hygiene Conference Committee - After coming to agreements on most of the issues before them last week, early this week the Mental Hygiene Conference Committee officially closed, reporting its progress to the General Conference Committee (also referred to as the ‘Mother ship’), chaired by Senate Majority Leader Joseph Bruno and Assembly Speaker Sheldon Silver.

Amongst their accomplishments were agreements to restore $4.3M (a major priority for MHANYS) in funding from the total of $7.7M cut in last year’s budget in the Aid to Localities portion of the budget.

In addition, the two houses agreed to put aside the issue of closing Middletown Psychiatric Center until the Office of Mental Health provides details as to how the closure would effect services and jobs in the Orange/Sullivan County area. It appears that it is the legislature’s intention to revisit this issue after May 4th when the details are to be forthcoming from OMH.

Lastly, in a change from last week’s Friday Fax, the Committee agreed to accept the Governor’s proposed merger of the Commission on Quality of Care for the Mentally Disabled (CQC) and the Office of the Advocate for Persons with Disabilities (OAPD), with some changes to preserve many of OAPD’s unique functions.

The final agreement provided to the legislative leaders can be viewed at http://www.assembly.state.ny.us/comm/Mental/20050321/SFY.pdf.

Health and Aging Conference Committee - At the Health and Aging Conference Committee, many more contentious issues were discussed than in other Committees – issues like Medicaid reform and hospital ‘right-sizing.’ Of particular interest to us were several issues, including the discussions about the implementation of a Preferred Drug Program and the proposed cuts to Family Health Plus.

Despite the objections MHANYS and other patient advocacy groups have raised, the Committee came to a “conceptual agreement” to move forward with the implementation of a Preferred Drug Program with some changes, including giving the doctor the final say as to whether a patient will be prescribed a drug on the ‘preferred’ list or not. “and additional consumer protections,” (which remain unresolved). It appears that the Committee was unable to reach further agreements on what else was necessary for the PDP to become law, including the nature of the “additional consumer protections” cited in the Committee’s final memo, and deferred such decisions to the ‘Mother ship’ Committee for the remainder of the details to be worked out.

There were also some positive outcomes from the Committee’s work included a rejection of the Governor’s proposal to make changes to the Family Health Plus program to make it consistent with the Healthy New York program, including the elimination of mental health coverage. However, as with Medicaid, co-payments for prescription drugs under Family Health Plus will increase, which we believe will be a change from $1 to $3.

To view the Health and Aging Conference Committee’s final report, go to http://www.assembly.state.ny.us/comm/WAM/20050324b/health.pdf.

On Friday morning, after several meetings throughout this week and last, the ‘Mother ship’ committee met again. However, instead of simply accepting the final reports of the various subcommittees, the conferees instead debated several issues pertaining to the implementation of taxes and fees, and various tax breaks. While there remain several issues on the ‘Mother ship’ committee’s table, it appears that by working through the weekend, the legislative leaders expect to come to agreement on the outstanding issues by Monday. This would allow for enough time for bills to be printed and age the necessary three days before legislators can act upon them, so that they could be passed into law before Friday, April 1st.

However, it is not as simple as that. Given the NYS Court of Appeals decision in December, the Governor now has a great deal more power to craft the state budget than the legislature, effectively leaving the legislature with little power in the budget making process. If the Senate and Assembly were to come to an agreement on the budget, it would require the Governor to agree to make the changes the legislature has agreed upon and resubmit his budget bills to reflect these changes. Meanwhile, the Governor has openly expressed criticism about the legislature’s actions, in that negotiations have not included him and his staff, and that he has doubts about the availability of the additional funds the legislature is working with to come to agreement on the budget. An article from The New York Times, which follows below, explains the entire dynamic in Albany in greater detail.

MHANYS’ ONLINE ADVOCACY: As any agreements reached in the legislature’s conference committee process must also pass in each of the two houses of the NYS Legislature, and there continues to be strong opposition to the Preferred Drug Program proposal from many legislators, MHANYS continues to encourage people to send their legislators an e-mail using our Online Advocacy function at http://www.mhanys.org/policy/advpld.htm. We continue to maintain that "There is absolutely no clinical evidence indicating that a PDP would improve the quality of care for Medicaid recipients. With that in mind, it appears that the only good PDP is no PDP."

ASSEMBLY’S KENDRA’S LAW PUBLIC HEARING RESCHEDULED: The public hearing on Kendra’s Law slated to take place on Thursday was postponed due to action on the budget. Instead, Assembly Mental Health Committee Chair Peter Rivera and Assembly Codes Committee Chair Joseph Lentol will hold this hearing on April 8th. The hearing will be held in New York City at 250 Broadway, Room 1923 at 10:30 a.m. Those interested in testifying should contact Jennifer Best at 518-455-4371.

MEDICARE PART D: Following below is an excellent briefing paper, produced by Michael Friedman, Director of the Center for Policy and Advocacy of The Mental Health Associations of New York City and Westchester, which addresses the impact that the new Medicare prescription drug benefit will have on ‘dual eligible’ New Yorkers (those who qualify for both Medicare and Medicaid). In addition, NMHA has posted information on this issue on their website at http://www.nmha.org/federal/MedicarePrescriptionDrugBenefit.cfm. These resources include: Frequently Asked Questions about Medicare Part D, Medicare Part D Timeline, Key Questions: Transition to Medicare Part D and State Legislation on Medicare Part D. Look for more information on Medicare Part D from us in the coming weeks.

THE CENTER FOR POLICY AND ADVOCACY
OF THE MENTAL HEALTH ASSOCIATIONS OF NEW YORK CITY AND WESTCHESTER

HUNDREDS OF THOUSANDS OF NEW YORKERS
MAY LOSE DRUG ACCESS ON JANUARY 1, 2006:
THE NEW MEDICARE DRUG BENEFIT

New York State Must Prepare for the Transition
by Educating Consumers Now

On January 1, 2006, Medicare will replace Medicaid as the payer for prescription drugs for over 600,000 people who are eligible for both Medicare and Medicaid (“dual eligibles”) in New York State.

Of these, over 200,000 have a mental or cognitive disorder. Over 85,000 are served in the public mental health system.

Medicare will use privately managed drug-only plans and Medicare HMOs to administer the new prescription drug benefit.

In order to receive drug coverage, dual eligibles will have to be enrolled in a prescription drug plan.

They may have a choice of plans if they enroll voluntarily. Otherwise, they will be randomly assigned to a plan among those with low-to-average premiums.

Different plans may have different formularies and pharmacy networks. As a result, drugs and pharmacies currently covered by Medicaid may or may not be covered by a Medicare plan.

Many people with mental and cognitive disorders have spent years putting together a medication regimen. During the transition from Medicaid to Medicare, these regimens are at great risk of being interrupted, and there could be terrible consequences for a person’s mental health.

Auto-assignment has been authorized because it is likely that a great many people will not enroll in drug plans voluntarily.

Auto-assignment will begin as early as October 2005. Dual eligibles will be randomly assigned to a drug plan and informed of their assignment. (Dual eligibles will be allowed to switch plans at any time.)

If the auto-enrollment system doesn’t work perfectly smoothly, Medicaid drug coverage may end for dual eligibles even though they aren’t actually enrolled in a Medicare drug plan.

Even if they are successfully auto-assigned to a Part D plan, it is likely that many dual eligibles will not know that they have new coverage, what plan they are enrolled in, what the plan covers, or what pharmacies are in the plan’s network.

As a result, hundreds of thousands of New Yorkers could be without access to medication in the early months of 2006, and the consequences could be disastrous. Some would likely die, some would relapse, some would end up in hospitals and nursing homes, and some would wind up on the streets or in jails and prisons.

To avoid such personal tragedies and their social consequences, a transition process should be implemented. Some possible options are:

• The federal government could allow continued Medicaid coverage during a transition period,
• Similarly New York State could extend Medicaid at state expense, or
• EPIC could be expanded to cover dual eligibles.

Whichever option is chosen, consumer education is absolutely essential.

This education would probably be best provided by organizations which have routine contact with dual eligibles, such as community health and mental health organizations, hospitals, family support organizations, consumer advocates, etc.

New York State should organize training programs for service providers so that they can help their consumers to enroll in appropriate medication management plans.

May is Mental Health Awareness Month

Second Annual Walk for Mental Health

Week of May 14 – May 20, 2005

In November of 2004, several advocates from across the state walked 122 miles in support of Timothy's Law. The walk went from Warwick, NY to Albany, NY and culminated in a rally of more than than 600 individuals gathered for Mental Health Parity.

This year, two advocates involved in the Walk for Timothy’s Law in Memory of Robin Jane Desrats, Ann Berardinelli of Families with Bi-Polar Children, and Ali Zimmerman, an employee of Independent Living, Inc., are planning an annual Walk for Mental Heath during May is Mental Health Month.

During the week of May 1st through the 20th, they will be getting walkers from each county to participate in a relay-type walk from the four corners of the state, converging on Albany on the 20th.

If you are interested in participating, please contact Ann or Alexandra - e-mail the Walk Committee at mentalhealth_walkers@yahoo.com, or call Ann at (845) 566-0810 or Ali at (845) 703-1042 and they will connect you with the agency coordinating the walk in your region.

IN THE NEWS:

Mentally ill inmates must not go to 'box.' Letter to the Editor
Albany Times Union, March 19, 2005

I commend the Times Union for its recent coverage ("Bill would bar solitary for mentally ill inmates," and editorial, "Hope in The Box") of the solitary confinement bill that is currently being debated in the state Legislature. The placement of people with mental illness in Special Housing Units, often referred to as "the box" or "solitary confinement," is cruel and unusual punishment.

As a member of Rights for People with Psychiatric Disabilities, I and other members of this group have seen the disturbingly real consequences that this treatment has on our loved ones.

I hope legislators will pass this important bill before more people with mental illness suffer, and in some instance die, in solitary confinement.

LEAH GITTER
New York
leahgitter@yahoo.com

Gaps wide as budget talks inch forward. By James M. Odato
Albany Times Union, March 22, 2005

Agreement near on preferred-drug list for Medicaid patients, but lawmakers divided on transportation, education

ALBANY -- Lawmakers missed their self-imposed deadline Monday to finish budget talks but were closing in on agreements aimed at saving tens of millions of dollars in health care costs.

Major divisions remained on transportation, health care and education funding, though legislative leaders still were talking of having a budget by the April 1 deadline. The state budget has been late for 20 straight years.

Senate Majority Leader Joseph L. Bruno and Assembly Speaker Sheldon Silver extended conference committee discussions through the end of this month, although their goal is to reach consensus on a budget deal by Thursday.

Among the money-saving strategies is a controversial "preferred-drug list" for Medicaid patients and others covered by the state. The list, proponents say, would feature less-costly but equally effective pharmaceuticals. Lawmakers have long insisted that doctors have the final say on medications.

Gov. George Pataki has favored the idea for years, and included a drug reform plan in his latest proposed budget that would save an estimated $76 million next year. The savings would grow over time.

Health subcommittee chairmen Assemblyman Richard Gottfried and Sen. Kemp Hannon said their chambers have a conceptual agreement on creating the list.

"We are a little closer than we were last year," Gottfried said.

The preferred drug list, annually opposed by many Hispanic lawmakers, will be the subject of a news conference with assemblymen Peter Rivera and Adriano Espaillat today. They argue the program would deny needed medications for Medicaid recipients.

"Last year, I led the fight to kill a preferred drug list because I believed it would be bad policy for our sickest and poorest residents," Rivera said. "Nothing has changed: health disparities continue to increase and our under-served populations still do not receive the care when and where they need it."

The measure is supported by big health care lobbies, including Service Employees International Union Local 1199, which has been lobbying heavily in Albany during the past week. Major drug companies oppose the idea.

Gottfried said his panel is looking to add $695 million more in spending to Pataki's budget plan for health care, but is awaiting the results of private discussions on ways to contain costs.

Gottfried and Hannon indicated talks are continuing on a new commission that would examine the surplus of hospital beds in New York and the question of closing unnecessary facilities. Lawmakers seem to agree overcapacity is draining resources from the health system.

Pataki said cost-containment talks with the Legislature have not produced any deals yet. He also voiced disappointment that the Legislature hasn't advanced budget bills on areas that it has agreed on so far.

Meanwhile, Sen. Thomas Libous, a leader of the transportation budget committee, said the Senate can't go along with the Assembly's plan to seek voter approval for $2.9 billion in borrowing to help fund a $35.4 billion capital program for roads, bridges and mass transit projects.

The key problem, he said, is the Assembly would use $1.6 billion for mass transit, and less for highway construction. The Senate also would not support the plan by the Assembly and Pataki for hefty new fees for registering vehicles to pay for transportation projects, he said.

Pataki hasn't said where he stands on the bond act idea.

Lawmakers were also split on public education. The Assembly is willing to accept Pataki's plan to include $325 million in video lottery terminal revenues for sound, basic education spending, largely in urban areas and New York City. Senate leaders have rebuffed the plan.

As April 1 Date Grows Near, Doubts on Budget Grow, Too. By Al Baker and Patrick D. Healy
The New York Times, March 25, 2005

ALBANY, March 24 - New York's Senate and Assembly on Thursday left undone some of the major work on a legislative counterproposal to Gov. George E. Pataki's budget, casting doubt on whether a budget could be adopted by the April 1 deadline for the first time in two decades.

While the state's two top legislative leaders admitted that big questions remained, particularly on how to cap local governments' share of Medicaid costs, they promised to wrap up by early on Friday. And, after a public meeting that ended about 5 p.m., the two congratulated themselves for keeping alive the hope of an on-time budget and walked to the governor's quarters for a public meeting he had called.

There, Mr. Pataki expressed a starkly critical view of their work.

Speaking plainly, the governor said that he had serious concerns about their continual tardiness and that he had expected more information from the legislative branch - both on policy and dollars-and-cents matters - by their self-imposed deadline of Thursday. And at one point, he practically pleaded to be brought back into the process.

"If you don't want us to be involved in the process - that's what it sounds like to me," Mr. Pataki said.

If lawmakers try to keep the governor out of the negotiations and pass their own budget, Mr. Pataki said he could rely on last year's ruling by the Court of Appeals that accorded him far more power than the Legislature in shaping a budget.

"I certainly have power that the Court of Appeals has upheld, and I have no intention of waiving them," he said, while declining to outline a specific legal strategy if lawmakers acted alone.

Based on his staff's early analysis of the Legislature's actions, Mr. Pataki said that in the areas of school aid, transportation, some health costs, and other items, "spending just seems well beyond what we believe is appropriate." He said he feared the Legislature was adding more to his $105.6 billion plan than the $1.5 billion it has mentioned.

The governor also said that even though lawmakers reached agreement on education spending - to increase it by $840 million over the current year - he did not know the specifics of their spending formula: whether money would continue to flow according to current formulas, for instance, or whether they would shift more money to the poorest school systems.

"We don't know at this point what their education proposal is," Mr. Pataki said. "We don't know what their transportation proposal is - we know in general terms, general numbers, but I don't believe they've worked out among themselves the details of those."

He added, "We don't know what they're doing on taxes or revenues."

The day in Albany was full of fits and starts. Public negotiating sessions were scheduled, postponed, then on again, off again, until finally a burst of talks started at 4:15 p.m. A budget subcommittee dealing with health announced an agreement: it would reject about $747 million worth of Mr. Pataki's cuts and institute a preferred drug list, as most states have, to save about $70 million in the first year. Mr. Pataki said it appeared the plan would cut too little to allow the state to capture a federal waiver worth about $1.5 billion.

Still, Joseph L. Bruno, the Republican leader of the Senate, and Sheldon Silver, the Democratic speaker of the Assembly, said that even with its multiple holes, their budget agreement was solid.

"We are not going to let the governor stop us from having a timely budget," Mr. Silver said, with Mr. Bruno at his side.

At the public meeting the governor called, the exchanges turned rapid fire. At one point, Mr. Bruno reminded the governor that the aim was to move forward. Mr. Silver suggested that the governor was trying to derail the legislative process.

Mr. Silver also said he had to leave shortly to attend services marking the start of Purim, a Jewish holiday. Indeed, many members had hoped to leave the Capitol to celebrate Purim, Good Friday and Easter.

Mr. Pataki, noting those religious observances, suggested a late-night session, and Mr. Silver said he could return in a few hours. The men discussed meeting at 11:30 p.m., although no one seemed certain that they would be ready to make an agreement by then.

Geriatric mental health, long-term care reform must be linked. By Michael B. Friedman
The Journal News, March 21, 2005

The rising costs of Medicaid have given fresh impetus to efforts to reduce the use of nursing homes by providing services to help older adults with disabilities to live in the community. These efforts cannot be fully effective if mental-health needs are ignored.

The importance of mental-health services to the effort to provide alternatives to nursing homes is often missed because the popular images of nursing home residents are of people who are demented and decrepit — of people with broken hips who never fully recover; of people with Parkinson's disease who can no longer stand, feed themselves, or control urinary or bowel functions; of people with Alzheimer's disease who can no longer recognize their own children.

These images reflect only part of the reality of nursing homes residents. They neglect the fact that mental and behavioral disorders are among the major reasons that people go to, and remain in, nursing homes.

Yes, many people in nursing homes have chronic physical illness or have failed to recover from injuries. But at least half of this population have co-occurring mental illnesses –– especially depression and anxiety disorders.

Yes, many people are in nursing homes because of dementia. But sometimes what is diagnosed as dementia is actually unrecognized depression. And many people correctly diagnosed with dementia also have depression and anxiety disorders that would respond to treatment.

In addition, 10 percent to 15 percent of people are in nursing homes primarily because they have mental illnesses, cannot care for themselves, and do not have family or friends to take care of them at home.

Finally, a great many people who are in nursing homes putatively because of dementia or physical illnesses or injuries are actually there because of their behavior. Home health workers, case managers and, most important, their families could manage their physical problems in the community if it weren't for such behavioral problems as wandering, non-adherence to medical regimens, belligerence, and actions that are dangerous to themselves and to others.

The fact that these mental and behavioral disorders are among the major reasons that people are put in nursing homes has important implications for the effort to reduce nursing home utilization.

• Every task force, planning group and advisory body convened to work out the details of restructuring should include experts on geriatric mental health.
• Home health and case-management services need to be reconceptualized as services to address mental-health and behavioral problems as well as health problems.
• The health, mental-health and aging service systems need to be integrated.
• Mental-health services need to be far more accessible than they are. There need to be more services. They need to be affordable. They need to be mobile so as to reach people in their homes and community settings where older people go for help. And they need to be designed to engage cultural minorities.
• The quality of mental-health services needs to be improved. Currently, primary care physicians provide most mental-health services in the community and frequently they are unable to make accurate diagnoses or provide the best treatment. In addition, many mental-health professionals are not prepared to serve older adults.
• Because families are the primary caregivers for people with mental and physical disabilities, significant attention needs to be devoted to supporting their extraordinary efforts.
• Of course, it is not realistic to believe that all older adults can continue to live independently or solely with the support of their families or friends. But nursing homes should not be the only next step. Alternative congregate housing should be available for older adults with co-occurring mental and physical problems.
• Widespread public education is needed to help older adults, their families, their physicians and others who care for them to understand what mental illness is, that it is treatable and where to go for good treatment. Public education also needs to address stigma and ageism.
• Substantial efforts are needed to develop a work force large enough and competent enough to meet the mental-health needs of older adults.
• Finally, the delivery of mental-health services that can help reduce the need for people to go to nursing homes will require a significant redesign of financing models.

None of this will be easy, but these are the challenges that must be confronted in order to restructure long-term care in ways that help people live where most prefer to live –– in their homes or home-like settings. It can't be done without addressing mental-health needs.

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