Early January 2006 NACBHDD Newsletter
The Newsletter of the National Association of County Behavioral Health and Developmental Disability Directors
In this Issue...
The 2005 NACBHDD Newsletter series is brought to you by:
Medicaid Update:
Cuts Not Yet Final; Final Attempt to Defeat Bill Looming
Most recent Congressional activity: $16 billion in cuts passed but bill not yet final. Just before the holidays, proposals for $16 billion in gross cuts in Medicaid over the next decade passed through the House and Senate. And, as reported in a December 22 electronic communication to NACBHD members forwarded from Tom Joseph, advocate for social services directors, although Congress adjourned for the holiday, the full House will have to vote again on the budget reconciliation cuts because of a Democratic procedural move in the Senate. The vote will occur when the full House returns January 31, although House speaker Hastert could call them back before then. Joseph reports that defeating the bill in the House will be "a huge uphill battle." And he reports, "The first vote in the House was 212-206 with 10 Republicans absent compared to just six Democrats. It must be noted that the copy of the 776 page bill was only made available at 1 a.m. and the vote occurred less than five hours later, so there are some Washington lobbyists who are arguing that some wavering members may be convinced to oppose the legislation because they did not understand the full implications of some of the cuts."
Areas of concern: targeted case management, higher co-pays and premiums. Reimbursement for targeted case management has been severely restricted. Also, states will be allowed to charge higher co-payments and premiums for many beneficiaries. For more information on targeted case management and the specific language passed by Congress, click here.
Next steps. Advocates, including the Campaign for Mental Health Reform, of which NACBHD is a member, are working to develop a strategy for a final attempt at defeating the bill. In addition, advocates are examining how the cuts will play out at the community level.
Resources
For information on the impact of the cuts on HHS programs, see the following links from the Center on Budget and Policy Priorities (CBPP). CBPP has a "special series of analyses" on the 2006 federal budget. The papers also include estimates made by the non-partisan Congressional Budget Office. To access CBPP and its various analyses, see www.cbpp.org. For specific bill analyses, see:
The overall bill:
http://www.cbpp.org/12-20-05bud.htm
TANF Changes:
http://www.cbpp.org/12-18-05bud2.htm
For more information on the budget, including TANF, foster care, child care, and Labor/Appropriations, see the December 22 communication to NACBHD members and the Washington Update sent to members on January 4.
More on NACBHD Medicaid advocacy efforts
In addition to ongoing work with the Campaign for Mental Health Reform on Medicaid, NACBHD is also putting a high priority on other Medicaid advocacy activities at this critical time, including:
Medicare Update
Important dates. CMS is now auto-enrolling approximately six million dually eligible beneficiaries (those receiving both Medicare and Medicaid) into Medicare prescription drug plans. These new Medicare drug plans will replace Medicaid as it is currently used by the dually eligible (and others) to support their access to medications. As of November 15, 2005, beneficiaries may select another plan from the one in which they are auto-enrolled. The new prescription coverage begins on January 1, 2006.
NACBHD Survey on MMA Part D Intended to Inform Congress and the Administration
On December 28, the NACBHD membership was sent an electronic notification regarding collecting information on the Medicare Modernization Act (MMA) Part D and its impact on dual eligibles. A simple six question survey is now available on the NACBHD website, so that members may answer questions that will provide information and data helpful in promoting implementation and program changes, if and when they are needed. Other DC advocacy groups such as the National Alliance for the Mentally Ill, the National Mental Health Association, the National Association of State Mental Health Program Directors, and the American Psychiatric Association, are also gathering data about dual eligibles. The following link will direct users to the log-in page, where the MMA survey is listed: http://www.nacbhd.org/members//member_login.cfm.
Please note that the deadline for completing the survey is March 15, so that members have an opportunity to assess the initial impact of the implementation, which begins January 1.
Mental Health Part D Web Site Provides Up-to-Date Resources
NACBHD recently spoke with Karen Sanders, M.S., the American Psychiatric Association's (APA) Associate Director for Publicly Funded Services and Sam Muszynski, J.D., Director, APA Office of Health Care Systems and Financing, about Mental Health Part D (www.mentalhealthpartd.org), a new web site that provides up-to-date information and resources related to Part D of the new Medicare law.
Background. Several years ago, the APA worked with the National Alliance for the Mentally Ill (NAMI) and the National Mental Health Association (NMHA) on Medicaid and access issues. The focus has shifted to Medicare and Part D, and the collaboration now involves more physician organizations and more mental health organizations including the American Association of Community Psychiatrists, the American Association of Geriatric Psychiatry, the American Psychiatric Association, the National Association of State Mental Health Program Directors, the National Council for Community Behavioral Healthcare, and the Treatment Effectiveness Now, as well as NAMI and NMHA.
The site. There are three portals of access on the site: Psychiatrists and Other Physicians, Providers at Community Behavioral Health and Integrated Health, and Consumers and Their Families. All of the collaborating organizations contributed to the portals. The News area changes routinely, with current news added from the Centers for Medicare and Medicaid Services. A timeline of key dates for Part D is on the site's home page.
Concerns related to dual eligibles. Muszynski and Sanders noted that an overriding concern for dual eligibles is access to medications and how to mitigate concerns about access. Muszynkski says minimizing the problems and translating concerns back to CMS are major challenges. According to CMS all is well, but the field needs direction, and the field is very broad. In addition, the awareness of the dual eligibles themselves about the change is variable. Some concerns Muszynski highlighted were:
What NACBHD members can do to help dual eligibles. Muszynski and Sanders said it will be helpful for NACBHD members to understand the copay issue, and what to do if there is a problem with it. They provided the information they are giving to providers working with dual eligibles:
Other Medicare Modernization Act Resources
Update on the Campaign for Mental Health Reform
The Campaign for Mental Health Reform continues to actively work with national advocacy partners on critical issues, such as Medicaid and the Reconciliation bill, and is also involved in events to focus the agenda for 2006, and to recognize efforts in the mental health arena. The current emphasis is on:
Medicaid and the Reconciliation bill
The Campaign is collaborating with a broad coalition of groups working to defeat the Reconciliation bill when the House votes on it in January or early February, with the Campaign alert to timing on the vote so that it can strategize accordingly. (See Medicaid article above for specific information on Medicaid and for more information and links on the Reconciliation bill.)
December policy retreat focuses priorities for 2006
The December 1 policy retreat, attended by Campaign member executive directors and lead policy staff, provided a time for Campaign partners, including NACBHD, to focus on priorities for 2006. About thirty-five people came, including CEOs from the Campaign Steering Committee, which is composed of the Bazelon Center for Mental Health Law, the National Mental Health Association, the National Alliance for the Mentally Ill, and the National Association of State Mental Health Program Directors. Each organization made a presentation on public policy issues related to mental health to determine which ones the Campaign would consider priorities for 2006. Melissa Staats discussed Medicaid eligibility and individuals incarcerated in county jails. The group was strategic in their consideration of topics, emphasizing issues likely to gain political support and likely to make a difference, and the range of issues was broad - and included Medicaid, veterans' benefits, criminal justice, and housing. Medicaid was chosen as a priority for 2006. The group will reconvene soon, with the time depending on Congressional action, to determine Campaign strategy. The Campaign strongly considered veterans' mental health benefits, as well as other public policy benefits.
First Annual Awards Dinner for Leadership in Mental Health
The First Annual Awards Dinner for Leadership in Mental Health, scheduled for March 29, 2006, at the Washington, DC, Grand Hyatt, will honor members of Congress and others who have made mental health a national priority. Melissa Staats is a Dinner Co-Chair, along with other directors of Campaign partner organizations.
NACBHD Members Invited to Participate in Cross-Site Evaluation of the National Child Traumatic Stress Initiative
The Center for Mental Health Services (CMHS) of SAMHSA is sponsoring a Cross-Site Evaluation of the CMHS-funded National Child Traumatic Stress Initiative (NCTSI) and its Network. The Network is composed of specialized centers across the nation that develop and use trauma-informed services, approaches, and systems to meet the special needs of children and adolescents who have been exposed to traumatic experiences such as abuse, neglect, domestic or community violence, disaster, terrorism, war or displacement, medical trauma, or grief/loss. The evaluation is being conducted by ORC Macro, in partnership with Walter R. MacDonald & Associates, and the National Association of State Mental Health Program Directors (NASMHPD) Research Institute. The overarching goals of the evaluation are to describe the children and families being served, to assess the development and dissemination of effective treatments and services, to evaluate network collaboration, and to assess the Network's broader impact. As part of this Cross-Site Evaluation, the NASMHPD Research Institute has been collaborating with NACBHD to explore how NACBHD members can be involved in the evaluation to provide feedback about this important CMHS-funded initiative. Along with other professional associations, members of NACBHD will be invited to participate in the national impact study component of the larger Cross-Site Evaluation. More information will be provided in the newsletter as the implementation time for the national impact study component approaches.
Legislative Conference: Mark Your Calendars for March 1, 2, and 3
Members are urged to mark their calendars for the NACBHD Annual Legislative Conference scheduled for March 1, 2, and 3 in Washington, DC. Registration and hotel information is available on the website, and reservations can be made directly with the hotel. NACBHD will host a special panel of state Medicaid directors and state mental health programs directors to talk about the future of Medicaid. NACBHD is hoping an end result will be the beginning of the development of a business model for transformation.
Annual Conference: "Transformation, Recovery, & Self-Determination" Information Soon Will Be Available
The NACBHD Annual Meeting took place October 20-22 in Portland, Oregon. The theme for this year's conference was "County Government and County-Sponsored Authorities Leading Transformation, Recovery, & Self-Determination." Consumers, county authorities, and staff from national advocacy organizations led discussions on issues critical for transformation to a recovery-based system. Information about the conference will be available soon on the NACBHD website.
SAMHSA Announcements
From a December 22 SAMHSA press release:
State of Maryland Receives More than $13.5 Million for Mental Health Transformation State Incentive Grant
SAMHSA Administrator Charles Curie has announced the award of $13.5 million to Maryland over five years for a Mental Health Transformation State Incentive Grant to transform the state's mental health system to reflect consumer and family needs and focus on facilitating recovery. Curie presented a symbolic "big check" to Governor Robert L. Ehrlich, Jr. during a ceremony in Annapolis. "This new grant will significantly advance the transformation agenda outlined in the federal action agenda for mental health care," Curie said. "People with mental disorders have a vital role to play in our families, our neighborhoods, our communities, and our country. Their ability to participate fully can no longer be derailed by outdated science, outmoded financing systems, and unspoken discrimination." "My Administration is deeply committed to empowering mental health providers to better care for their patients," said Governor Ehrlich. "This important grant from SAMHSA is yet another step in that direction and builds on our considerable successes to date in providing the best mental health care possible in Maryland ." The Maryland award is part of $92.5 million awarded to seven states. The states that receive the awards, administered by SAMHSA's Center for Mental Health Services, will serve as platforms for learning about what strategies and activities do and do not work in transforming the states' mental health and related systems. In partnerships with these states, SAMHSA will communicate successful strategies and activities to other states, territories, and tribes and tribal organizations in order to improve and accelerate transformation across the nation. Maryland's grant - totaling $2,713,887 for the first year- will be used to facilitate deep and lasting change in the way services are delivered, in part by enhancing the already strong public-academic and public-private provider partnerships in the areas of evidence-based practices and by emphasizing a recovery-focused approach to service. The grants require the grantees to enlist consumers and family members as active partners in all transformation planning and activities. They also require grantees to take a life span approach to services and to provide a continuum of services including promotion, prevention, treatment, and recovery.
From a December 7 SAMHSA press release:
HHS Secretary Leavitt Unveils National PSA Campaign To Provide Mental Health Services To Hurricane Survivors
HHS Secretary Mike Leavitt has launched a national public service advertising (PSA) campaign designed to encourage people who may be experiencing psychological distress following the recent hurricanes to consider seeking mental health services. The PSAs, the result of a partnership between SAMHSA and the Ad Council, will be distributed to 12,000 media outlets nationwide.
According to SAMHSA, past research on the mental health consequences of major floods and hurricanes suggests that the psychological impacts of the recent hurricanes could be extensive. SAMHSA estimates that -- in those areas that have been significantly impacted by the hurricanes -- 25 percent to 30 percent of the population may experience clinically significant mental health needs and an additional 10 percent to 20 percent may show sub-clinical, but not trivial, needs. Up to 500,000 people may be in need of assistance. "Since the beginning of this unprecedented disaster we have been concerned about the mental well-being of those impacted," Secretary Leavitt said. "We've continued to work with the states to provide access to mental health and substance abuse services to help Americans through this tough time. I hope these public service announcements, our toll-free number and website will provide information and support to those who need help." People who were displaced by the storms have lost their homes, schools, communities, places of worship, daily routines, social support, personal possessions and much more. In some cases, these losses were coupled with losing loved ones and witnessing death, destruction and criminal violence. According to SAMHSA, the psychological impact of these experiences can be both serious and long-lasting. Symptoms of Post Traumatic Stress Disorder -- including depression, grief and anger -- are to be expected among some who survived the hurricanes. They may also develop physical health and behavior problems, such as substance abuse disorders among adults and conduct problems among children. Some of these problems may not surface for months or years. "Most hurricane survivors demonstrate remarkable resiliency and will rebuild theirs lives without significant mental or substance abuse issues," SAMHSA Administrator Charles Curie said. "We also know that there are a smaller but still significant number of people who will have difficulty achieving recovery without professional assistance. Help is a phone call away."
The new PSA campaign is designed to help adults, children and first responders who have been impacted by the hurricanes and are in need of mental health services. The campaign includes television and radio spots, which are available in English and Spanish, and addresses the fears, thoughts, concerns and questions faced by the victims. The PSAs aim to reach adult victims and first responders directly, as well as parents and caregivers who can assess their children's emotional well-being. Viewers and listeners are encouraged to take time to check in on how they and their families are doing, and call a confidential toll-free number 1-800-789-2647 for adults/parents and 1-800-273-TALK for first responders to speak to a trained professional who can assist with information and referrals to local services, or visit www.samhsa.gov. To view the ads, visit www.samhsa.gov. The PSAs are being distributed to television and radio stations nationwide via the FastChannel Network and will air in advertising time that will be donated by the media.
From a December 29 SAMHSA press release:
Nine Percent of Adolescents Experienced a Major Depressive Episode in the Past Year, Survey Finds
About 2.2 million adolescents ages 12 to 17 (9 percent) experienced at least one major depressive episode in the past year. These adolescents were more than twice as likely to have used illicit drugs in the past month than their peers who had not experienced a major depressive episode (21.2 percent compared with 9.6 percent). These findings were released today by SAMHSA from continued analysis of the 2004 National Survey on Drug Use and Health. The survey includes questions to assess lifetime and past year major depressive episodes. A major depressive episode is defined using the diagnostic criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). These criteria specify a period of two weeks or longer during which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration and self-image. "These new data serve as a wake-up call to parents. Mental health is a critical part of the overall health and wellbeing of their children," said SAMHSA Administrator Charles Curie. "If parents have concerns about their child's behavior or emotions, they should discuss their concerns with their doctors, teachers, counselors, social workers, spiritual advisors, friends, or relatives who know about child development and mental health. Ask for help in finding out what the problem is and where to get services. Unfortunately, less than half of these children received any help for their depression." In the survey, treatment for depression is defined as seeing or talking to a medical doctor or other health professional or taking prescription medication for depression.
The report, "Depression Among Adolescents," found that older teens are more likely than younger teens to experience a major depressive episode in the past year. An estimated 12.3 percent of adolescents ages 16 or 17 suffered a major depressive episode in the past year compared to 9 percent of those ages 14 or 15 and 5.4 percent of those ages 12 or 13. An estimated 21.2 percent of adolescents ages 12 to 17 who suffered a major depressive episode in the past year reported past month illicit drug use compared to 9.6 percent of those who did not. Similarly, 28.4 percent of those teens suffering a major depressive episode in the past year reported past month alcohol use, compared to 16.5 percent of teens who did not report a major depressive episode in the past year. Almost one quarter (22.8 percent) of adolescents ages 12 to 17 who experienced a major depressive episode in the past year used cigarettes in the past month compared to 10.7 percent without a major depressive episode.
The National Survey on Drug Use and Health is an annual survey of close to 70,000 people ages 12 and older. The survey collects information from residents of households, residents of non-institutionalized group quarters and civilians living on military bases. The report is available on the web at www.oas.samhsa.gov. For more information on child and adolescent mental health go to http://www.mentalhealth.samhsa.gov/child/childhealth.asp.
