November 9, 2006

SPITZER-PATERSON WIN ELECTION AND PREPARE TO
TAKE OVER REINS OF STATE GOVERNMENT

In Tuesday’s election, Attorney General Eliot Spitzer and NYS Senate Minority Leader David Paterson won their bid to become the next Governor and Lieutenant Governor of New York State, respectively.

Already, they have assembled a transition team to make the transfer of power on January 1st a smooth one. Following below are the individuals named to the Spitzer-Paterson transition team, according to the Associated Press today:

• Richard Parsons, chairman of the board and CEO of Time Warner Inc. He served as co-chairman of New York City Mayor Michael Bloomberg's Commission on Economic Opportunity and chairman emeritus of the Partnership for New York City.
• Peter C. Goldmark, Jr., director of the Climate and Air Program at Environmental Defense, an anti-pollution organization. He had been CEO of the International Herald Tribune. He was Carey's budget director when Carey rescued the city from financial disaster.
• Elizabeth D. Moore, a partner at the law firm of Nixon Peabody. She runs the firm's Diversity Action Committee and worked in the administration of Gov. Mario Cuomo.
• Lloyd Constantine, chairman of the law firm Constantine Cannon in New York and Washington. He is the former state assistant attorney general in charge of antitrust enforcement, a position that ended in 1991 well before Spitzer took office. He was the chairman of Spitzer's transition committee when he became attorney general in 1998-99.
• Hunter Rawlings, president emeritus of Cornell University.
• Rosanna Rosado, publisher of El Diario/La Prensa, the Spanish language newspaper.

Two other staffers named Thursday were:
• Paul Francis as transition policy director. He helped Spitzer develop many of the detailed positions for the campaign. He is on leave as managing partner of the Cedar Street Group, a small venture capital fund he founded.
• Francine James as transition appointments director. She has been Spitzer's assistant first deputy attorney general.

MHANYS is looking forward to working with the incoming Spitzer-Paterson Administration to improve the lives of New Yorkers living with psychiatric disabilities.

OMH RELEASES NEW PROS REGS, RESUMES IMPLEMENTATION:
NYAPRS UPDATE ON PROS

Effective last Thursday, the NYS Office of Mental Health issued newly revised regulations for its PROS (Personalized Recovery Oriented Services) Medicaid rehabilitation licensed program. Issued as emergency regulations, they take place immediately.

Included are revisions necessary to support changes in the following areas:
• The new units-based reimbursement methodology
• Revised documentation standards regarding the IRP, relapse prevention plan and assurances that medical necessity standards are being met
• The new client registration system
• Addition of ‘cognitive remediation’ service and clarifications on the other services
• Clarification on face to face and off site definitions
• Factoring in recent increases (COLA for the CSR base rates and IR and ORS add-ons and the increase to the clinic treatment add-on)
• Clarification on new group size limitations
• Establishes minimum time frame for provision of services
• Use of nurse practitioner to partially offset the requirement for psychiatrist coverage
• Clarifies rules for recovery of funds where there is dual enrollment in PROS and ACT, PMHP, and DOH and/or OMRDD-licensed programs
• 18 month period to reach professional staffing requirements
• Provides for transition to new rules for existing PROS provider

You can find the regulations at http://www.omh.state.ny.us/omhweb/policy/part_512_emergency.htm.

You can also find a summary of the major changes contained in the new regulations at http://www.omh.state.ny.us/omhweb/policy/part_512-pros.htm

NYAPRS will be issuing an analysis shortly.

It appears that OMH will now resume implementation of PROS in the remaining 6 ‘early adopter’ counties, possibly starting with Suffolk and Orange.

$2.2 MILLION IN GRANTS AWARDED TO 32 ADULT CARE FACILITIES:
NYS Department of Health Press Release

ALBANY, November 8, 2006 - New York State Health Commissioner Antonia C. Novello, M.D., M.P.H., Dr.P.H., today announced a total of $2.2 million in state grants to 32 adult care facilities across the state to help improve the independence and quality of life of their residents.

"Governor Pataki and I are strongly committed to improving the quality of life for the residents of adult care facilities throughout New York State by empowering the residents themselves through the use of innovative programs," said Commissioner Novello.

First authorized in 2004, the Enhancing Abilities and Life Experience (EnAbLE) initiative was established to develop programs designed to teach independent living skills, provide educational or vocational training or teach residents preventive health care skills and management of their own medications.

EnAbLE is an opportunity for operators of Adult Homes, Enriched Housing Programs and Residences for Adults to offer a variety of supportive services for residents, including participation in wellness and nutrition programs, independent living skills training, increased opportunities to participate in community activities and social opportunities, maintaining memory or engaging in supervised activity to improve physical condition and reduce falls or injuries.

The following adult care facilities were awarded funding under this initiative:

Metropolitan Region
Queens Adult Care Center $98,000
New Central Manor $99,500
Sanford Home $100,000
Hoffman Manor of Long Beach $99,841
109 West 129th Street $61,980
Plattduetsche Old Folks Home Society $49,925
Anna Erika Assisted Living $94,870
West 74th Street Home $42,130
New Haven Manor for Adults $99,538
New Brookhaven Townhouse for Adults $98,000
Marion Woods, Inc. $43,000
Frederic Fleming Residence $39,310
Green Briar Adult Home $99,220
Gables Home for Adults $99,500
Capital District
Family and Child Service of Schenectady, Inc. $36,494
The Terrace at Glen Eddy $48,431
Massry Residence at Daughters of Sarah $61,196
Beacon Pointe Memory Care Community $49,277
Central New York
Presbyterian Residential Community $34,035
Rescue Mission Alliance of Syracuse NY, Inc. $78,078
Elizabeth Brewster House $87,888
Loretto at Nottingham $26,115
Western Region
St. Columban's on the Lake $89,087
DePaul $82,644
Peregrine's Landing Senior Community, Cheektowaga $65,588
Elderwood Village at Westwood $98,514
Elderwood Village at Rosewood $98,514
Bergquist Adult Home $41,400
St. Elizabeth's Home $59,662
Crimson Ridge Meadows $26,050
Quaker Landing Memory Care Community $47,840
Crimson Ridge Gardens $46,633

IN THE NEWS:

Insurer Sued for Refusing to Pay Costs of Anorexia. By Tina Kelley.
The New York Times, November 9, 2006

NEWARK, Nov. 8 — A New Jersey couple filed suit against Aetna Inc., the Hartford-based insurance company, on Wednesday, claiming that it refused to fully cover their daughter’s treatment for anorexia.

The suit was filed in United States District Court here. The couple, Cliff and Maria DeAnna of Mountainside, N.J., said Aetna refused to pay for nearly 10 weeks of their daughter’s inpatient treatment, saying her eating disorder was not “biologically based.” Insurers have balked at covering mental illnesses that they say do not have a proven physiological basis.

Ms. DeAnna, who declined to provide her daughter’s given name for privacy reasons, said by phone that she had been hospitalized for 101 days so far this year but that Aetna U.S. Healthcare H.M.O. would pay for only 35 inpatient days. Symptoms of anorexia include excessive dieting and exercise and a distorted belief that one is overweight.

The case is an example of what advocates for the mentally ill call longstanding inequities in insurance coverage for psychological ailments. The family’s lawyer, Bruce Nagel, said state law required insurers to provide the same coverage for mental and nervous conditions as for physiological diseases, like heart ailments or emphysema. The suit estimates that hundreds of people in New Jersey have had similar difficulties receiving coverage, and it seeks certification as a class action. Ms. DeAnna estimates that her family has paid almost $100,000 in medical bills this year alone, with the help of a home equity loan. Her daughter, who is 20 and stands 5-foot-6, weighed 102 pounds when she last went into the hospital.

A spokeswoman for Aetna, Cynthia B. Michener, said the company had not yet been served with the suit and could not discuss a particular case without written authorization from the family involved.

Anorexia has a high mortality rate, said Lynn Grefe, the chief executive of the National Eating Disorders Association, a nonprofit group based in Seattle.

While many lawmakers and insurance companies have struggled to define anorexia, some medical experts question the usefulness of the term “biologically based” to describe a disease. Ms. Grefe said that Thomas R. Insel, the director of the National Institute of Mental Health, which is part of the National Institutes of Health, has said research has established that the disease is a brain disorder.

“While the symptoms are behavioral, this illness has a biological core, with genetic components, changes in brain activity and neural pathways currently under study,” he wrote in an Oct. 5 letter to her.

Ms. Grefe said she was not aware of any other class-action suits seeking insurance coverage for anorexia, “but it’s about time.”

According to the National Association of Anorexia Nervosa and Associated Disorders, a nonprofit organization based in Highland Park, Ill., a judge in a 1989 case against Blue Cross and Blue Shield of Greater New York ruled that starvation resulting from anorexia is a physical state that should be covered by medical benefits.

In 2001, Blue Cross and Blue Shield agreed to pay $8.2 million to the state of Minnesota to settle a suit filed by the state involving treatment denied to a 21-year-old anorexic woman who committed suicide. Her family paid for her treatment but sued Blue Cross for refusing to pay for it. The insurer also settled with the family for $1 million.

Mental Health Problems from Katrina Persist. By Dorie Turner
Washington Post, November 9, 2006

ATLANTA, Nov. 8 -- Hurricane Katrina left more than gutted houses and empty streets along the Gulf Coast.

The most devastating impact of the storm, which killed thousands of people and destroyed entire towns, can be seen in the desperate faces of people more than a year later, survivors and rescue workers said in a panel discussion Wednesday.

The panel was part of an annual Carter Center symposium on mental health policy. This year's focus is on the psychological effects of Hurricane Katrina.

Panelists said mentally ill patients are still unable to get treatment and medicine because so few services are available in New Orleans and other damaged cities. But the storm also triggered mental problems -- most commonly depression and anxiety -- in people who had never before had them.

"When you see your neighbor's body floating by, it's pretty traumatizing," said Jeff Wellborn, assistant commander for crisis transportation services at the New Orleans Police Department.

Wellborn's unit handles all calls to police involving mentally ill people. With just two of the city's 11 hospitals operating, officers can take only the most serious cases in for medical attention, he said.

Law enforcement agencies in New Orleans and neighboring Jefferson Parish say they are answering more calls than before the storm about domestic abuse, drunkenness and fights. Involuntary commitments to mental hospitals are up from last year, and the number of suicides in Orleans Parish has tripled.

James Cooper, who works for the Extra Mile, which recruits volunteers for the Louisiana Department of Health and Hospitals, said he is frustrated that the federal government has done little to help pay for mental health services for hurricane survivors. And mental health professionals have nowhere to turn for help with their own anxiety from the storm, he said.

"It's so hard for them to deal with what they had to go through, and then to deal with clients all day long," Cooper said.

Wellborn said many police officers in New Orleans have not sought help for the trauma they suffered from rescuing stranded residents and policing essentially lawless streets. Officers are having trouble controlling their tempers and are getting into altercations with people on routine calls.

The symposium, which has been held annually for 21 years, brings mental health professionals from around the country together to discuss how to help people with psychological distress.

"Hurricane Katrina is teaching us much about the long-term psychological impact of disasters," Rosalynn Carter, wife of former president Jimmy Carter, said in an e-mailed statement. "We brought people together at the Carter Center to ensure that mental health needs are a priority in responding to future disasters."