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March
31, 2006
BUDGET UPDATE: We have some additional information about the finalized budget agreed to by the Assembly and Senate that they are voting on today. However, this is occurring as Governor Pataki has been reported in the media to be threatening vetoes of certain portions of the legislature’s agreement. Nonetheless, this is what the Assembly and Senate agreed to earlier this week: As regular readers of the Update will recall, mental health advocates have been advocating for funding for community-based mental health providers. The Senate and Assembly have agreed to an additional $3.335 million in funding to bring community-based providers who were cut two years ago by the $7.7 million reduction in funding for “aid to localities” back up to the funding level they were at two years ago. We appreciate working alongside NYAPRS and other advocates in this effort. The legislature also agreed to the 2.5% COLA proposed in the Governor’s executive budget proposal. And it appears that the Legislature has rejected the Governor’s plan to transfer Camp Pharsalia from the Department of Correctional Services to the Office of Mental Health for the purposes of creating a facility dedicated specifically to house civilly committed sex offenders. It appears that they want to come to an agreement on the specifics of a law to civilly commit sex offenders, which could greatly impact the number of offenders civilly committed, before determining how much money to allocate for such a facility. The Governor has expressed his displeasure regarding some of these agreements between the Assembly and Senate and has said he would like to negotiate some reductions in spending with the legislature.
OMH ANNOUNCES BRIEFINGS AND PUBLIC HEARINGS ON 2006-2010 STATEWIDE COMPREHENSIVE PLAN FOR MENTAL HEALTH SERVICES: From the OMH website - http://www.omh.state.ny.us/omhweb/news/publichearing_2006.htm.
IN THE NEWS: Study
Backs Equal Coverage for Mental Ills. By Robert Pear WASHINGTON, March 29 — Providing insurance coverage for mental illness equal to that for physical illness does not drive up the cost of mental health care as many insurers feared, a new study of health benefits for federal employees says. President Bill Clinton ordered such equal coverage for federal workers in 1999, and the changes took effect in 2001. Under the policy, known as parity, insurers were forbidden to charge higher co-payments or impose stricter limits on psychiatric care or treatment for alcohol and drug abuse. The new study of those changes, being published Thursday in The New England Journal of Medicine, concludes that if mental health care is properly managed, expanding the coverage of it "can improve insurance protection without increasing total costs" beyond those paid by insurers that do not offer parity. Providing equal coverage for treatment of mental disorders did not increase the use of mental health services under the federal employee program, the researchers said. But it did lead to "significant reductions in out-of-pocket spending" for many government workers and retirees. A co-author of the study, Richard G. Frank, professor of health economics at Harvard, said, "The big winners, in terms of reduced out-of-pocket spending, were the sickest patients, including those who needed hospital care." In the past, a federal employee often had to pay 30 percent to 40 percent of the cost of a hospital stay for a mental illness like major depression. With parity, the patient did not have to pay any of the cost, saving $300 to $400 a day in a hospital that charged $1,000 a day. Dr. Howard H. Goldman, a professor of psychiatry at the University of Maryland, who led the research team, said insurers had borne slightly more of the costs after the adoption of mental health parity. The researchers said they did not know whether any of those costs had been passed on to subscribers, in the form of higher premiums. But "even if the full cost of the new requirement was passed on to subscribers," he said, "the impact on premiums would be very small, probably less than half a percentage point." Psychiatrists, psychologists, patients and their advocates have tried for decades to eliminate disparities in insurance coverage for mental and physical illnesses. Under the change ordered by Mr. Clinton to the Federal Employees Health Benefits Program, coverage must be "identical with regard to traditional medical care deductibles, coinsurance, co-payments" and limits on hospital stays and doctor visits. The new study tried to measure the effect of Mr. Clinton's order by comparing the claims experience of seven health insurance plans within the federal program and several health plans offered by large private employers that did not provide parity. The researchers found increased use of mental health services, and increased spending for mental health care, under both types of insurance. The increase for federal employees was similar to that for the private-sector workers, and was not attributable to the requirement for parity, the study found. Amanda L. Austin of the National Federation of Independent Business, a trade group for small businesses, said the experience of the federal program was not necessarily relevant to them. Fewer than half the federation's 600,000 companies offer health insurance to their employees, and "the No. 1 reason is cost," Ms. Austin said. "The Federal Employees Health Benefits Program, with a pool of nearly nine million members, is very different from the type of insurance plans available to a small business with three employees."
Mental
Health Coverage Affordable, Study Finds. By Christopher Lee A new study involving federal employees has found that providing better mental health coverage does not lead to an explosion in insurance costs, a potentially important development in an old national debate over what insurance plans should cover. The study, published today in the New England Journal of Medicine, examined seven federal health plans in the years after 1999, when President Bill Clinton ordered companies in the Federal Employees Health Benefits Program to provide coverage for mental health and substance abuse that is comparable to that for other health conditions. Researchers found that, contrary to the predictions of some policymakers and analysts, the use and cost of such services did not increase, compared with the experience of private health plans with less generous mental health benefits -- provided that new benefits were offered under managed-care plans. The changes did, however, mean lower out-of-pocket expenses for people who used the services under the federal plans. "These results are important, because it means that it is affordable for all of us who have health insurance to have better protection in the event that we might need to use mental health or substance abuse services," said Howard H. Goldman, the lead researcher and professor of psychiatry at the University of Maryland School of Medicine. The findings provide ammunition for advocates of mental health "parity" in the long-running battle in Congress and state legislatures over whether health insurance companies should be required to offer mental health coverage that is equivalent to the coverage they offer for physical diseases such as cancer or diabetes. Such expanded coverage is ardently supported by mental health professionals and patients' groups, who say it would eliminate long-standing discrimination against people who are mentally ill. Just as passionately, leading business groups almost unanimously oppose such a requirement, saying it would increase insurance premiums and force some employers to scale back coverage for physical diseases or drop health benefits altogether. In general, mental health and substance abuse coverage has come with higher out-of-pocket costs to patients and greater restrictions on office visits and days in the hospital. Ralph Ibson, a vice president with the nonprofit National Mental Health Association, said the study shows that requiring mental health parity in employer-provided insurance plans is a good idea that will not break the bank. "This study, which is certainly enormous and robust, very decisively puts to rest some of the major myths that opponents have brought to this debate, the principal myth being that to enact and implement parity is to increase health-care costs," Ibson said. Edwina Rogers, vice president for health policy at the ERISA Industry Committee, an association of major employers, said a single study does not settle the argument and that costs are still a concern. "The data can be massaged on either side of this particular debate," Rogers said. "There is a big push in the mental health community to kind of force the government to say they have this right to sort of a steady stream of benefits, to mandate it. What they are asking for is just not appropriate." Rogers said many large employers already offer generous mental health coverage. Goldman and other researchers, working under contract to the federal government, looked at seven FEHB plans from 1999 to 2002, comparing them to similar plans in the private sector that did not offer enhanced mental health and substance abuse coverage. More than 300,000 people were continuously enrolled in each set of plans. The research team found that the rates of spending on, and use of, mental health and substance abuse services rose in both groups over the study period, but no more so in the federal group than in the other one. At the same time, enrollees in five of the seven federal plans saw average reductions in out-of-pocket spending ranging from $14 to $87 a year. The plans were managed-care plans. "Managed care has figured out how to direct care and prioritize things within budgets," said Richard G. Frank, a professor of health economics at Harvard Medical School. "What our results suggest is that if you are going to do parity and you are concerned about cost growth, then parity is a good idea if it's done along with managed care."
Sex
offender confinement upheld. By Jennifer Smith ALBANY - A state appeals court bolstered Gov. George Pataki's effort to confine sex offenders who have served their sentences by ruling that 12 sex offenders he ordered moved from prison to mental hospitals last fall had been properly committed and did not have their constitutional rights violated. Lawyers for the offenders had argued that the men were illegally moved from prison to psychiatric facilities on Wards Island because they had not had pre-commitment hearings, as required by state correction law. Yesterday, the State Supreme Court's appellate division unanimously rejected that argument, saying correction law did not apply because the sex offenders had been committed on their release from prison, making them subject only to the due process protections afforded by the state's mental hygiene law. Justice Bernard J. Malone's decision reversed a November ruling ordering the offenders' conditional release and noted that all of them had been found to be "so dangerously mentally ill as to require their involuntary civil commitment to inpatient psychiatric facilities.” Pataki praised the ruling. The decision lends momentum to the governor's push to use existing mental health law to detain sex offenders who have served their sentences but are considered too dangerous to be released. Pataki first proposed a civil confinement law in 1999 but resorted to this tactic after such legislation repeatedly failed to pass the Assembly. Forty-nine sex offenders have been confined in this manner since October, according to the statement. Stephen Harkavy of Mental Hygiene Legal Service, a state agency that provides legal representation to psychiatric patients and which represented the 12 sex offenders in the case, said he will likely appeal the decision. "It's hard to say that they were free," Harkavy said of the men. "They were sent over in correctional vehicles, in shackles and orange jumpsuits." It was not clear what impact the ruling - which essentially said Pataki's strategy was legal under existing mental health law - would have on two proposed civil commitment bills being considered in the legislature. Both the Senate and the Assembly have set forth their own versions of a civil commitment law, but efforts to reconcile the two bills have stalled during negotiations over the state budget.
Pataki
plan to pay for fewer off-plan drugs will save Medicaid $$$.
Editorial With prescription drug prices largely responsible for the recent spike in state Medicaid spending, Gov. George Pataki is justified in trying to do something — anything — to corral the situation. His proposal to make it harder for doctors to prescribe drugs not on the state’s "preferred drug list" may have raised the hackles of consumer activists and advocates for the poor and elderly, but it’s not as bad as they’re making it seem. Preferred drug lists are used by many private insurers to keep doctors from prescribing the latest — and most expensive — medicines. The fact is, several effective options — including generics — are often available, and one may be several times more expensive than another. The state also, in effect, negotiates volume discounts with the drug companies, getting rebates in exchange for putting the drugs on the preferred list. And while doctors should generally give the cheaper option a try, not all do. (This is especially true of doctors who receive favors, like free samples or fancy meals, from the drug makers when they’re rolling out new products.) Under Pataki’s new plan, docs would still be able to prescribe offlist, but they’d have to make an acceptable case for doing so to the state Health Department — not unlike they already do with other insurers. And the DOH could say no (which it currently doesn’t do.) The restriction may be a nuisance for doctors, but it will save an estimated $36 million a year. That’s worth it.
Bill
Aims To Aid Mentally Ill Inmates. By Rick Karlin Lawmaker Supports Proposal To Abolish Solitary Confinement For Affected Prisoners ALBANY -- New York would be a national leader if it passed a bill banning solitary confinement for mentally ill prisoners, a legislator close to the issue said on Tuesday. But it remains uncertain whether the Pataki administration will agree to it. "We'd be out front," said Assemblyman Jeffrion Aubry, Queens, who has been spearheading efforts to limit the use of Special Housing Units, or SHUs, for those diagnosed with mental illness. Some state prisons, including Great Meadows, have started working with alternate methods of dealing with mentally ill inmates, including the use of intensive counseling sessions. During a Tuesday news conference to promote the measure, Aubry noted that the Assembly on Monday passed a bill curtailing use of the SHUs. The Senate is taking up the measure, he said, although it was unclear if the governor would approve such a move. Aubry said he suspected the state's Department of Correctional Services may be resistant to a mandate regarding its operations. "No agency wants to be told what to do," Aubry said. Department of Correctional Services spokesman Mike Fraser said his agency doesn't comment on pending legislation. Aubry's remarks came after former inmates and relatives of inmates spoke of the horrors and hardships of confinement in the tiny SHUs, where prisoners are kept for up to 23 hours a day. "I spent most of my days crying," Danyta Jefferson, who suffers from bipolar disorder, said of her time in an SHU after throwing a cup of water at a prison guard. "They said he hung himself, but I'm not sure how he died," said Elsie Butler, whose son James W. Butler Jr., apparently hanged himself in 2003 in the Fishkill Correctional Facility after six months in the SHU. She said her son had a well-documented history of suffering from manic-depressive illness.
Bill
keeps mentally ill inmates out of solitary. By Erik Kriss Now that prison guards are supporting a bill to ban the use of solitary confinement to discipline seriously mentally ill inmates, the Central New York senator who sponsors the legislation is ready to try to push the measure through his house. Mental health advocates were in Albany Tuesday to support the bill, which also calls for increased treatment for such inmates. It passed the Assembly 135-7 this week. Sen. Michael Nozzolio, the Seneca County Republican who chairs the Crime Victims, Crime and Correction Committee, wants the Senate to follow suit. He called the support of the New York State Correctional Officers and Police Benevolent Association union "critical" to his efforts to see the bill through. He also credited teachers and counselors who work at prisons and are represented by the politically powerful Public Employees Federation. For the Mental Health Alternatives to Solitary Confinement group and other groups, the issue is one of humane treatment. Nozzolio and the advocates acknowledged the possibility of a gubernatorial veto if the bill passes the Senate, saying the state Department of Correctional Services is less than enthusiastic about legislation mandating changes in its procedures.
Letter
to the Editor. With national media focusing extensively on issues such as port security, long-standing concerns like Americans’ health security are receiving less attention. Our health security, however, may be at great risk from soon-to-be-made decisions in the nation’s Capital as Congress moves to take up a budget plan. Just weeks ago, Congress passed legislation inviting states to cut billions from the Medicaid program. Those cuts will undoubtedly fall heavily on the most vulnerable Americans, often people whose lives have been changed by grave accident, chronic illness or old age. But with the ink on the budget-cutting law hardly dry, the president has proposed yet another round of Medicaid budget cuts. It’s not as if Medicaid is ineffective. It’s the lifeline enabling millions of people with mental illnesses to live in their communities instead of in costly institutions. Yet the recent cuts, as well as the Administration’s plan to shrink a sweeping number of federal health-related programs, come at a time when we need far greater federal investment in health security — not less. A presidentially-established commission on mental health, for example, advised making mental health a national priority. Failing to do so has dire results ranging from loss of life to increased business, societal and taxpayer costs. Mental health problems claim 30,000 suicide victims annually and are taking a serious toll on returning veterans. Children are among the most vulnerable; as the President’s Commission reported, “No other illnesses damage so many children so seriously.” Developing a congressional budget plan is an exercise in priority-setting. Our elected representatives in Washington must press for a budget plan that champions the health security of Americans and, at last, makes mental health a real national priority. Colleen
Merlo
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