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MENTAL HEALTH UPDATE - INDEX

February 10, 2006

SAVE THE DATE: MHANYS' LEGISLATIVE DAY MARCH 13, 2006

MHANYS TESTIFIES AT JOINT LEGISLATIVE BUDGET HEARING ON HEALTH AND MEDICAID: Following is MHANYS’ testimony.

Thank you very much, Chairmen Johnson and Farrell, Senator Hannon and Assemblymember Gottfried, for providing us with the opportunity to submit testimony regarding Governor Pataki’s 2006-07 Executive budget proposal. We appreciate the opportunity to explain our perspective regarding issues contained in this portion of the Governor’s budget proposal that impact people living with mental health needs throughout this state.

Briefly, the Mental Health Association in New York State, Inc. (MHANYS) is comprised of 30 affiliates across New York State representing 54 counties. Our affiliates vary greatly in their size and the services they provide – from small organizations that simply provide education and advocacy about mental health, to mental health service providers, often times the largest within a region.

Many people with mental health needs are reliant upon programs, such as Medicaid, to keep them healthy and stable. Without these programs, many people would deteriorate to the point where they need hospitalization or end up entangled with the criminal justice system.

It is for this reason that MHANYS is concerned about many of the Governor’s proposals with regard to the health portion of the budget, which includes funding for Medicaid and other crucial programs. As an active member of the Medicaid Matters New York coalition, we wholeheartedly support the positions this organization takes, many of which are outlined below.

Medicare Part D
This year, perhaps of greatest concern to us are issues related to the state’s response to the Federal government’s new prescription drug coverage program, otherwise known as Medicare Part D. Over the past year, MHANYS has played an active role in assisting people with mental health needs, many of whom are on both Medicare and Medicaid (dual eligibles), make the mandatory transition to Medicare as the primary provider of medications. This changeover has been less than smooth, causing many people to go without the medications that allow them to remain healthy and stable. Problems have arisen due to computer glitches, mass confusion about how the benefit is supposed to work, and the inability of many to pay the now-mandatory co-pays required to access medications under the new drug benefit, which were not required under Medicaid.

As the January 1st implementation date approached, many advocates for dual eligibles were relieved by the Pataki administration’s promises to provide “wrap around” coverage to dual eligibles denied medications under their Part D plan. Indeed, we are very pleased that the Governor has provided this coverage for dual eligibles via executive orders extended on a weekly basis. However, we were alarmed to see that the Governor’s proposal would eliminate such “wrap around” coverage under Medicaid on July 1st, except for certain mental health, HIV/AIDS, and transplant medications. While we are pleased that “wrap around” coverage for some mental health medications would continue, the health needs of those living with mental illness often go far beyond mental health medications. In this regard, we believe that such “wrap around” coverage for medications denied under a Part D plan to a dual eligible should be continued at least until the end of the 2006-07 fiscal year. This would allow for a thorough examination of the status of the new Medicare prescription drug benefit and any continued problems with accessing medications one year after implementation.

Another major barrier to successful implementation of Medicare Part D for dual eligibles has been the mandatory co-payments required for accessing medications under this new benefit. Under Medicaid, if an individual was unable to make such a co-payment, access to a medication could not be denied. Now, if an individual is unable to produce the co-payment under Medicare, unless the pharmacist covers the co-pay, that person will be forced to leave the pharmacy without their medications. We strongly support any efforts the state can take to help dual eligibles unable to pay the mandatory co-payments, which would ensure continued access to their medications.

Preferred Drug Program
For the past several years, MHANYS has remained opposed to the implementation of a Preferred Drug Program (PDP) under Medicaid for fear that such a program would restrict access to medications for people with complex health needs, including those living with mental illness. While we were disappointed that the PDP was enacted last year, several safeguards were included in the final legislation that created additional patient protections; 1) atypical anti-psychotic and anti-depressant medications were exempted from the provisions requiring prior authorization; 2) consumer representation was included on the Pharmacy and Therapeutics (P & T) Committee; 3) considerations about cost were specifically excluded from the factors used to determine which drugs would be ‘preferred’, and; 4) the physician was given the authority to make the final decision about which medication a patient would get, not the program administrators.

Many of these safeguards are crucial to the safe implementation of this program. However, we have been very disappointed to see many areas in which these safeguards have not been honored. First, is in the composition of the Pharmacy and Therapeutics Committee, which is supposed to include 3 consumer representatives – only one has been appointed so far. Second, is the requirement for a doctor to get prior authorization before prescribing a long-lasting, injectible atypical anti-psychotic, despite the fact that the law specifically states that “no prior authorization shall be required under the preferred drug program for: (a) atypical anti-psychotics…”

Now, the Governor’s budget proposal includes recommendations to eliminate the ability of the doctor to make the final determination about which drug a patient will get. In addition, the Governor also wants cost to be considered when determining which drugs should require prior authorization under the PDP. These proposals, in concert with the failure to adhere to the specifics of the law authorized by the Legislature, give us great concern.

We strongly urge the Legislature to reject these attempts by the Governor to eliminate these crucial safeguards. In addition, we hope the Legislature will examine the P & T Committee’s authority to make decisions without the complete Committee having been appointed, and to examine the authority of the PDP to require prior authorization for classes of medications specifically identified in the law as exempt.

We also hope that the Legislature will require the Department of Health to continue to provide 30 days notice of upcoming P & T Committee meetings and of any decisions, rather than reducing that window of time to 10 days.

Adult Homes
Over the last several years, we were pleased to see that the administration had committed millions of dollars to adult home reform. Last year, the Governor and Legislature’s provision of an SSI increase to adult home residents translated to a much needed $19 per month increase in the Personal Needs Allowance for each resident. However, this year, a notably glaring omission in the Governor’s health budget proposal is in the area dealing with adult homes.

As part of the New York State Coalition for Adult Home Reform (NYSCAHR), we asked the Governor to include funding for the following initiatives in his budget proposal: creation of more independent settings; assistance to help people move through the creation of housing assistance application programs; supportive congregate housing; legal and lay advocacy; air conditioning for residents; independent case management, and; assistance to help adult home recipients cover the now mandatory co-payments required under Medicare Part D. Despite these requests, there is only $2.75M for a range of services and expenses related to adult home initiatives, which could include legal and lay advocacy and for grants under the EnAble program.

In a recent letter to the Governor, NYSCAHR encouraged the Governor to include $5.25M in funding for independent case managers, $5M for air conditioning, $1.5M for housing assistance application programs, and $1M for legal and lay advocacy. MHANYS also urges supports efforts to provide additional funding for programs designed to help individuals in adult homes gain additional recovery-oriented services that would help them live successfully in the community.

Family Health Plus
Last year, we were pleased that the Legislature rejected the Governor’s proposed elimination of coverage for mental health services under Family Health Plus. This year, we urge you to reject the Governor’s proposal to greatly increase co-payments for emergency services, and also reject his recommendation that all co-payments be a mandatory component of accessing care under this program.

Mandatory Enrollment of SSI Beneficiaries in Managed Care
As part of the administration’s proposal, the Governor calls for the acceleration of the mandatory enrollment in managed care for SSI recipients. He also plans to require that all individuals with a serious and persistent mental illness (SPMI) be required to enroll in managed care for their health coverage, leaving all mental health coverage in a fee-for-service model (due to statutory restrictions). These components are included in the budget solely due to their projected savings – the Governor has the administrative authority to make these changes and does not require Legislative approval for these actions. However the Governor does require Legislative authorization to change the minimum number of managed care providers that must be present in a county in order for SSI recipients to be mandated to enroll in a HMO. The Governor’s proposal would change this from two to one provider.

We are very concerned about the impact that such a proposal could have on the overall healthcare that an SSI recipient receives. It is our concern that such a change would bifurcate health care for individuals on SSI with mental illness, with no communication between the mental health service provider(s) and those providing the rest of the person’s health care under the managed care model.

One of MHANYS’ goals is to ensure that integration between mental and physical health care exists. Only through legislation or regulation can such integration be assured.

The case management available to all individuals under the managed care model must incorporate all aspects of that person’s health, including all mental health and other care that person is receiving, even if those services are not provided by the managed care company.

With regard to the change that would require mandatory enrollment in managed care for all SSI recipients in counties where there is only one provider, we believe that such a mandate should only be imposed on those living in counties where a choice of managed care organizations exists.

Conclusion
Once again, thank you for the opportunity to provide you with our thoughts in regard to the Governor’s budget proposal. In summary, though we are appreciative of the proposed carve out of mental health drugs in the PDP, we have great concerns with the overall PDP, as well as other proposed Medicaid cuts - including the elimination of mental health coverage from Family Health Plus. With regard to Medicare Part D, we sincerely hope that the state will take all actions possible to make this change in prescription drug coverage as painless as possible through “wrap around” coverage and assistance with co-pays. We thank you very much for providing us with the opportunity to share our thoughts regarding the Governor’s budget proposal.

 

NYS COUNCIL FOR COMMUNITY BEHAVIORAL HEALTHCARE TO HOLD TRAINING EVENT ON “MEDICAL NECESSITY: STATE & FEDERAL AUDIT READINESS IN A CHANGING COMPLIANCE ENVIRONMENT”:

What: “Medical Necessity: State & Federal Audit Readiness in a Changing Compliance Environment”

Trainer: Mary Thornton, RN, MBA, NYS Council training consultant

Where: Nassau County (specific location TBD – likely to be Huntington)

When: Thursday, April 6, 2006, 10:30 – 4:00

Cost: NYS Council members in good standing = $85/pp. Non-members = $100/pp.

For additional information, contact Lauri Cole, Executive Director, NYS Council for Community Behavioral Healthcare at (518) 445-2642 or NYSCouncil@nycap.rr.com

 

IN THE NEWS:

Pataki veto rolled back. By James M. Odato
Albany Times Union, February 8, 2006

Legislators unanimously reject governor's stance, require state to pick up drug costs not covered by Medicare plan

ALBANY -- In a remarkable rejection of Gov. George Pataki's wishes, the Senate Tuesday unanimously joined the Assembly in a veto override, putting every member of both houses against the governor on a measure to safeguard prescription drug coverage for the elderly.

The Senate overrode Pataki's veto by a 58-0 vote without any debate. On Monday, the Assembly voted 141-0 in the same swift manner.

The override means the Legislature's law takes effect immediately. It calls for the state to pick up costs for medications not covered under Medicare D, the federal prescription drug program that started Jan. 1, but has several "glitches," according to Health Commissioner Antonia Novello.

Novello on Tuesday defended Pataki's veto, pointing out technical problems with the Legislature's measure. She said the governor already approved picking up the tab through March 8 for an estimated 600,000 people who, for various reasons, aren't showing up on Medicare rolls. They include people who were on Medicaid, the health program for the poor, but were supposed to be automatically transferred to Medicare D.

Pataki also called for picking up costs through July 1 for people in the system whose health plans aren't recognizing certain prescriptions.

Pataki's aides said the Legislature's move smacked of politics. Spokesman Kevin Quinn said the legislative fix is "an expensive election-year placebo that doesn't offer any new relief to our seniors and ultimately lets the federal government off the hook."

However, lawmakers said their action was necessary to assure senior citizens that they'll be able to get their prescriptions for as long as it takes to end the problems with the federal program.

Capitol long-timers said Pataki did something remarkable in unifying the Legislature against his veto.

"I think that's pretty striking, to have unanimous votes to override in both houses," said Assembly Health Committee Chairman Richard Gottfried. "I don't think I've seen that in 36 years."

He said Pataki has never made a rational excuse for the veto, adding that the assertion that it will be more expensive for the state doesn't make sense. Many states, he said, are doing the same thing as New York, paying for the medications with the expectation that the federal government will pay full reimbursement.

Novello said the state has already spent $68 million paying for the prescriptions that should have been picked up under Medicare.

"The lives of many poor New Yorkers have been placed at risk by the reckless and inept federal rollout of a flawed Medicare drug program by the Bush administration," said Robert Hayes of the Medicare Rights Center in Manhattan. "The Assembly and Senate deserve credit for enacting a safety net to protect the health and lives of New Yorkers in need."

In a separate issue Tuesday, Novello told lawmakers at a joint legislative budget hearing that health care cuts proposed by Pataki but criticized by hospitals and nursing homes can work as part of an overall strategy to trim the state's more than $46 billion Medicaid costs. Health care interests say the institutions can't afford the cuts, which include $431 million for hospitals and $288 million for nursing homes.

Novello told reporters that hospitals' complaints are "the same old 'Cry Me A River' " she has heard for seven straight years.

 

Good move protecting seniors. Editorial
Buffalo News, February 10, 2006

Legislature correct to make sure New Yorkers get needed medications

New York State lawmakers voted this week to reassure senior citizens after the federal foul-up in providing an understandable way to sign up for Medicare's new prescription drug program. Given the federal track record, this law is smart.

The law ensures that up to 600,000 low-income elderly and disabled New Yorkers can continue getting their medications despite the confusion in Medicare. The state already has been covering insurance gaps, but this extends the practice past a March deadline and includes some Medicaid recipients.

The real fix must come at the federal level, which is providing the drug coverage benefit but failed to make it simple enough. The feds eventually were shamed into promising to pay back states that had stepped in to help folks who suddenly couldn't get their medications or had to pay hundreds of dollars for them; in New York, that price tag has hit $68 million.

Gov. George E. Pataki vetoed the Legislature's bill to make that coverage a state guarantee, arguing that New York already had stepped in and it shouldn't enshrine that emergency intervention as another state entitlement. Both houses of the Legislature, far more attuned to public sentiment in an election year, unanimously overrode his veto.

Pataki is sending mixed messages on health care. Buried in his budget is another troubling move, a cost-cutting shift of 91,000 seniors from the simple state EPIC drug plan into the confusing array of new Medicare plans. But the governor also boosted health care by adding an $18 million amendment to his budget this week to fund a state-of-the-art Roswell Park Cancer Institute pharmacology research facility.

After the override, though, seniors at least have some added confidence that their prescriptions will be covered. This state guarantee will have to be watched to make sure it doesn't turn into a huge financial drain, but the bottom line is that government shouldn't be adding to the pain of those whose lives already have enough of that.

 

N.Y.U. Plans Mental Health Center for Children. By Richard Perez-Pena
The New York Times, February 9, 2006

New York University plans to build what it says will be the nation's largest pediatric mental health center to treat thousands of children and train thousands of doctors, and Gov. George E. Pataki has pledged more than $65 million in state funds for the project, which will help address a pressing need.

The centerpiece will be a $110 million 120,000-square-foot Child Studies Center on First Avenue, between 25th and 26th Streets, to open in 2009, university officials said. It will be dedicated mostly to outpatient treatment and research, but will have a small number of inpatient beds. The project also includes the construction of a children's psychiatric hospital in Rockland County.

The project, will be formally announced today at a ceremony with Governor Pataki and Mayor Michael R. Bloomberg. The state will contribute $30 million toward the center in Manhattan, the entire $35 million cost of building the Rockland hospital, and an undetermined amount — also in the millions of dollars — on research staff members at the hospital. Including a $50 million endowment the university hopes to raise for the Child Studies Center, N.Y.U. put the price of the entire effort at $200 million.

New York has an acute shortage of mental health services for children, especially for those on Medicaid, the government health plan for the poor. Children on Medicaid routinely wait many months to see therapists, and some give up and go without care. Each year, more than 1,000 children who need psychiatric hospitalization are sent out of state because there is no place in New York for them.

The state has long resisted granting new licenses for mental health centers. Some centers, like the one N.Y.U. has now, were able get licenses to operate, but not to be Medicaid providers.

But people involved in mental health say that in the last few years the state has become somewhat more receptive to allowing new centers. This year Mr. Pataki added $62 million for pediatric mental health services to his proposed budget. In N.Y.U.'s case, the state plans not only to allow a new center — an enormous one, at that — but also to license it to accept Medicaid payment, to cover a large share of the cost.

The governor said in an interview that the emphasis on research was a big part of the project's appeal, that "as new treatments, new concepts arrive, we're going to make sure that New York" is a leader in developing them. "We're going to do the most advanced treatment in the world, but we're also going to find the nature of the problems."

Dr. Harold S. Koplewicz, the director of the Child Studies Center, said, "We've been talking to the governor about this for two years, and I think he has recognized that instead of building new jail cells and wondering why kids drop out of school, if we front-loaded this and built more treatment centers, trained more doctors, that would be better."

The current N.Y.U. center accepts about 2,000 new children each year for outpatient treatment, and Dr. Koplewicz said that in the new center the number "will at least triple, if not quadruple." In addition to expanding its work on depression, anxiety, attention deficit and hyperactivity disorder, and other common problems, he said, the center will focus on autism, eating disorders and the science of genetics and the brain.

The number of child psychiatrists the center trains each year will double to 16, Dr. Koplewicz said.

"But more important," he said, "because there are never going to be enough child psychiatrists, eventually, we're going to train thousands of pediatricians a year in identifying and treating depression, anxiety, A.D.H.D. and autism as a routine part of their practice."

Mr. Bloomberg said that the center held out "the promise of revolutionizing our understanding of these types of mental health problems," and that "it will bolster our city's position as a global leader in medical and bioscience research."

News of the project — and the state's involvement in it — surprised people who work in children's health. Phillip A. Saperia, executive director of the Coalition of Voluntary Mental Health Agencies, a trade group, said the project was the latest sign, and perhaps the most impressive, of a change in the state's approach to children's mental health. "This is a very big deal," he said.

Dr. Irwin Redlener, president of the Children's Health Fund, which operates several clinics, said, "This is fantastic news." He added, "Whatever Harold Koplewicz did to make this happen needs to be replicated, because the state has been so adamant about not licensing or paying for new facilities."

Jeremy Snyder, 14, who has A.D.H.D., said that like many young people, he found that before he started going to N.Y.U.'s center, "It was such a struggle to find places to go, especially anyplace that could address all of my needs under one roof." He said the center had helped him overcome behavioral and academic problems.

The state operates a psychiatric hospital complex in Orangeburg, in Rockland County, and N.Y.U. plans to replace the existing pediatric hospital there with the one it intends to build. The plan is to use N.Y.U. students and faculty as staff members and bolster the research done there.

 

Judge Freeing 10 Pervs - Nixes Pataki Again. By Dareh Gregorian and Kenneth Lovett
NY Post, February 10, 2006

A Manhattan judge says the state's inaction is forcing her to order the release of another 10 violent sexual predators.

State Supreme Court Justice Jacqueline Silbermann yesterday found that the state was violating the due process rights of ten convicted predators who've been ordered confined beyond their prison terms, and directed the men be released if they don't get proper hearings within the next 20 days.

The decision was the second time Silbermann has ruled in favor of perverts — and she's not happy about it.

Gov. Pataki slammed a similar ruling by the judge late last year ordering that up to a dozen pervs be freed — a decision that's been on hold pending appeal — but Silbermann said she's just following the law.

The judge wrote that she had the "desire to assist Governor Pataki in his attempt to protect our citizenry, especially our children, from future attacks by individuals believed to be repeat offenders of sexually violent crimes." But "this court again is put in the untenable position of attempting to 'do justice' by applying existing statutes."

A spokesman for Pataki said the state plans to appeal the new ruling.

In her prior decision, Silbermann noted that Pataki had told state officials to "push the envelope" on existing confinement laws while he pressured the state Assembly to pass new laws, something he's been urging for years.

Pataki's push has resulted in prison officials committing the predators to a secure psychiatric hospital as soon as they're freed.

The pervs' legal advocates say there are ways for the men to be legally held after their release by granting the prisoners the right to challenge their confinement, but that the state has done an end run around those laws.

Pataki spokesman Kevin Quinn called the decision "deja vu all over again."

"This ruling once again creates special projections for violent sexual predators and gives them more rights than law abiding New Yorkers," he said.

He also called on the Assembly to pass a tougher civil confinement bill to avoid court cases like the one decided yesterday.

The Assembly has its own legislation that Republicans say is far too weak.

"The Assembly leadership is playing beat the clock with the lives of the most vulnerable New Yorkers — our children," Quinn said.