December 2006 NACBHDD Newsletter
The Newsletter of the National Association of County Behavioral Health and Developmental Disability Directors
In this Issue...
NACBHD News
NACBHD Represented at the Carter Center Symposium
NACBHD President and CEO Melissa Staats attended the 22nd Annual Rosalynn Carter Symposium on Mental Health Policy: Disaster Mental Health in the Wake of Hurricane Katrina on November 8 and 9 in Atlanta. Highlights included a panel discussion with David Satcher, MD, Ph.D., Director of the Center of Excellence for Health Disparities, Morehouse School of Medicine, and others, called "Disaster Response: Science to Practice," and a session presented by hurricane survivors, including representatives from the New Orleans Police Department and Project Recovery (the FEMA crisis counseling program) as well as an individual in recovery from mental illness and substance abuse who also runs a peer program.
In addition, two half days were devoted to six working groups charged with developing recommendations for improving disaster preparedness for individuals with disabilities. The recommendations of the work groups will be synthesized into a report from the symposium. Look for more information on the symposium report in a future newsletter.
Save the Date: NACBHD Legislative Conference February 28 - March 2, 2007
NACBHD's annual Legislative Conference is scheduled for February 28 through March 1 at the Jurys Hotel in Washington, DC. This year's conference is an opportunity to hear first hand from federal representatives and national advocacy partners what those in the behavioral health field may expect with the change in Congressional leadership.
To access a registration form for the conference, click here. Rooms at the Jurys Hotel can be reserved by calling 1-866-534-6835. (The room rate is $179. Use NACBHD as the group identifier.)
While all conference materials have been posted to the NACBHD web site, a draft agenda for the meeting can be accessed by clicking here.
In addition to the items listed on the conference agenda, NACBHD is pleased to announce that representatives from Alicia Smith & Associates (a Washington, DC consulting firm involved in quality and cost efficiency issues in health and human services programs including Medicaid, Medicare, SCHIP, and TANF) will be present to discuss the federal budget and how that may impact the Centers for Medicaid and Medicare Services, particularly in the developmental disability arena.In very early October, NACBHD staff disseminated 2007 Membership Campaign materials. In the package, each member (and potential member) should have received notice about NACBHD's decision to move to a population base for dues determination. As mentioned in the notice, this change is not intended to increase dues - although this did occur in some cases. The change is intended to facilitate enrollment and to move the organization in line with NACo. Members are encouraged to contact NACBHD staff if the new dues structure creates a burden to continued participation. In anticipation, the NACBHD board has established a 2 year window, meaning that members can pay the same amount of dues paid in 2006 for 2007 and 2008--to allow sufficient time to obtain support (in the case of dues increases where they may have occurred).
NACBHD is pleased to announce that the following states now have 100% participation (all counties) in NACBHD: Pennsylvania, Kansas, Utah, Alabama, California, and Michigan. A special thanks to the state association directors who worked hard to make this happen in their respective states.
NACBHD is most appreciative of all its membership and anticipates a great year in 2007.
NACo Prescription Drug Program: A Tremendous Success and Real Savings
TNACBHD recently spoke with Andrew Goldschmidt, Director Membership/Marketing for the National Association of Counties (NACo) about the Prescription Drug Program, which has grown significantly in just over a year since its inception, with over 600 counties participating, 1.45 million prescriptions filled, and $16.375 million saved. And, Goldschmidt says that 500 more counties are considering the program. NACo does not make any money off of the program; all savings are reinvested back into the program.
Nine out of ten, or about 59,000 pharmacies participate in the program, and Goldschmidt says NACo has received very positive feedback from consumers and pharmacists.
Who uses the program?
The program is for county residents, and is mostly used by the uninsured, the underinsured, senior citizens, jail inmates, and for some pet prescriptions.
What are the savings for an individual consumer?
Savings for individuals using the card average 21.6% off brand drugs and the already established generic price. (This varies by drug. For example, Golschmidt explains that the savings on a generic antibiotic may be 70%, while the savings on a $6,000 cancer drug may bring the cost of the drug to $1,000.) There has been an upward trend of .1% on the savings every month since the program began.
How do consumers become part of the program?
For individuals to participate in the program, there is no application process and no cost to participate. And, a consumer does not have to prove that they are uninsured or underinsured. They will find tear-off information on joining the program in brochures in hospitals, libraries, and county tax bills, for example. (See the next section.)
Are there any limitations on medications?
There are no exclusions in the formulary for psychotropic medications; it is a complete across the board formulary, and Goldschmidt says he has yet to hear of an exclusion. Most of the cards are used in person, with 1% of the usage being by mail order.
How do counties become members of the program and implement it?
Counties that are members of NACo can access the program through the NACo web site at www.naco.org. Click on Members Only, then see Prescription Drug Program. (If a county is not a member of NACo, they can join and access the program.) A full array of tools for implementing the program is available for member counties on the web site, including a marketing strategy and examples of best practices. A brochure with a tear-off card is typically distributed to county institutions, such as libraries and hospitals and in county tax bills.
There is no cost to counties to implement the program; NACo provides all the tools, and implementation requires a small amount of county staff time. Goldschmidt estimates the staff time might average one or two hours a month at the beginning and intermittently as press releases need reissuing.
How can I provide feedback and find out more information?
Goldschmidt encourages NACBHD to both "spread the word" about the program and to provide feedback about it. For more information, including a list of participating pharmacies, see the NACo web site at www.naco.org.
For specific questions about the program or to provide feedback, contact Andrew Goldschmidt at agoldschmidt@naco.org.
Mental Health Parity Act Extended Through 2007
On December 14, Peter Newbould (American Psychological Association ) and Chris Koyanagi (Bazelon Center for Mental Health Law), Mental Health Liaison Group Health Policy Committee Cochairs, electronically distributed the following information to the Mental Health Liaison Group, of which NACBHD is a member.
Adjournment Sees One Year Extension of Law (Parity Alert #42)
Congress has passed a one year extension of the Mental Health Parity Act of 1996, giving parity proponents another chance in the new Congress to make the case for ending the discrimination against those who suffer from mental or substance use disorders.
This extension to December 31, 2007 was included in the massive "Tax Relief and Health Care Act of 2006" as Section 115. It was not controversial.
While we were not successful in bringing the proposed full parity legislation to a vote in Congress we are optimistic that we can build on the greater understanding of the issue achieved over this two-year period.
We thank you and your organization for assisting in pursuit of parity legislation. We will be back in touch as parity sponsors plan their 2007 push for its passage.
Accomplishments:
NAMI Perspective on the Latest Results of the CATIE Study
An article in the December 1 issue of the American Journal of Psychiatry on the cost-effectiveness findings of the National Institute of Mental Health-funded (NIMH) Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE) has resulted in questions and concerns about the study from advocates, families and clinicians.
The National Alliance on Mental Illness (NAMI) responded to the article immediately. On December 1, Ken Duckworth, M.D., Medical Director, NAMI, issued a statement titled, "NIMH Study of Schizophrenia Drugs Requires 'New Thinking' in Research, Not Restrictions Based on Cost." Some key points from the statement are highlighted below:Read NIMH press release on the cost-effectiveness results of CATIE...
Mental Health Advocates Comment of Latest FDA Warning on Antidepressants
Julio C Abreu, Senior Director, Government Affairs, National Mental Health Association recently sent the following information to advocates:
FDA Panel Recommends Warning for Adult Antidepressant Suicide Risk
Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=41675
An FDA advisory panel on Wednesday voted 6-2 in favor of updating black box warnings on antidepressants to state that there is an increased suicide risk for young adults up to age 25, the New York Times reports (Carey, New York Times, 12/13). According to FDA's review, for every 1,000 young adults ages 18 to 24 who are given the drugs, about four will act on suicidal thoughts who otherwise would not have done so. The review found that the drugs did not increase the risk of suicide in adults ages 25 to 65 and that they significantly lowered the risk of suicide in people older than 65. Antidepressants since 2004 have carried a black box warning about an increased risk of suicidal thoughts and actions in children and adolescents (New York Times, 12/13). FDA proposed adding new warnings about suicide risk in young adults, which the advisory panel has now endorsed. The advisory panel "also encouraged the FDA to add language to the black box about the importance of treating depression in hopes that the addition of new warnings won't cause doctors to limit the antidepressant prescriptions," the Journal reports (Wall Street Journal, 12/14).
FDA Comments
Thomas Laughren, director of FDA's division of psychiatry products, said, "We don't know" why antidepressants appear to have different effects on different age groups (Graham, Baltimore Sun, 12/14). Laughren said FDA is leaning toward expanding the black box warning to include young adults, and agency officials said they will try to write language that would encourage health care providers to prescribe the drugs carefully, not abandon them, the Washington Post reports. Robert Temple, director of FDA's Office of Medical Policy, said that regulators are in a difficult position because they are obligated to warn physicians about monitoring patients for suicidal tendencies but also are concerned that the warning might lead doctors to stop prescribing the drugs (Vedantam, Washington Post, 12/14).
Testimony
Davis Shern, president of Mental Health America, said that the current black box warning for children and adolescents has resulted in a 20% drop in antidepressant prescriptions for those age groups. At the same time, Shern noted the suicide rate for children and adolescents has increased, according to some estimates. He said, "A black box warning will scare people away from treatment and end up causing greater harm than it does good" (Baltimore Sun, 12/14). Christopher Kratochvil, a psychiatrist and spokesperson for the American Academy of Child and Adolescent Psychiatry; John Mann, a psychiatrist and spokesperson for the American Foundation for Suicide Prevention; and Donna Barnes, president of the National Organization for People of Color Against Suicide, all said that new suicide warnings might harm depression patients by making them afraid of treatment. However, British psychiatrist David Healy and Harvard University lecturer and psychiatrist Joseph Glenmullen said that FDA's review downplayed the risk of suicide from antidepressants and suggested that several suicides in industry-sponsored
studies were never disclosed, the Post reports (Washington Post,12/14).
Broadcast Coverage
Experts in Developmental Disability Quality and Cost Issues To Present at Legislative Conference
In addition to the items listed on the Legislative Conference (February 28-March 1) agenda, NACBHD is pleased to announce that representatives from Alicia Smith & Associates (a Washington, DC consulting firm involved in quality and cost efficiency issues in health and human services programs including Medicaid, Medicare, SCHIP, and TANF) will be present to discuss the federal budget and how that may impact the Centers for Medicaid and Medicare Services, particularly in the developmental disability arena.
Combating Autism Act Approved by the Senate
The following information is summarized from a press December 7 release from the Autism Society of America.. For the complete press release see: http://www.autism-society.org/site/News2?page=NewsArticle&id=9173&news_iv_ctrl=-1
The Senate passed S. 843, the Combating Autism Act, on December 7. The Act provides for nearly $1 billion in federal funding for research, early detection, and intervention, through 2011.
Senators Santorum and Dodd authored the legislation, which was first passed unanimously in the Senate in August. The House approved an amended version of the bill on December 6.
The Autism Society of America (ASA), a chief advocacy organization, has applauded the legislation, and in a press release stated: "ASA thanks Chairmen Enzi and Barton for their leadership," said Lee Grossman, ASA President and CEO. "This is only the beginning of our commitment to ensure federal funding to support and serve all affected by autism."
The ASA press release lists the key provisions of the Act as follows:
Autism Resources from the Autism Society of America
NThe following resources, among others, are available from the Autism Society of America's web site at www.autism-society.org.
AutismSource
This database contains thousands of resources with listings in all 50 states. Programs are added on an ongoing basis, and users can recommend resources by following the prompts on the site. Resources including physicians, psychologists, speech, occupational and behavioral therapists, schools, camps, training programs, government agencies, and more can be accessed at: www.autismsource.org.
Medicaid Waiver Programs
Under Medicaid Waiver Programs, for which participants receive Medicaid and Waiver services, a parent's income is waived when assessing Medicaid eligibility. According to the ASA site, "These programs are geared towards providing services to families who have a child living at home. It is through these programs that families can gain skills, maintain structure for their child and get a break from caregiving."
Waiver services vary between states, and not all states provide Medicaid Waiver Services. New York has a high demand for waiver respite and residential habilitation. (Residential Habilitation consists of in-home programming.) State Developmental Disabilities Councils or the Health Care Financing Administration can be contacted for additional information.
Other Resources
The ASA web site has information, and in some cases, direct links to other resources members may find useful in assisting families, including information on financial resources and benefits, applying for financial resources and benefits, special needs trust/supplemental needs trust, family reimbursement programs, accessing a service coordinator/ case manager, a career center for members of the autism community seeking employment as well as for employers seeking qualified applicants, and an online bookstore. Access these resources...From a November 29 SAMHSA press release:
Nearly Half of all Patients in Treatment for Both Alcohol and Drugs
The proportion of patients in treatment for drug and alcohol abuse made up nearly half of all clients (47 percent) according to the National Survey of Substance Abuse Treatment Services (N-SSATS): 2005, released today by SAMHSA.
The survey showed that on March 31, 2005, 1.08 million people were enrolled in substance abuse treatment, an 8 percent increase from 1 million in 2000. Of them, 34 percent were in treatment for drug abuse only, up from 29 percent in 2000. In contrast, clients enrolled in treatment only for alcohol abuse declined from 23 percent in 2000 to 19 percent in 2005.
N-SSATS: 2005 contains data on the location, characteristics, and use of alcoholism and drug abuse treatment facilities and services throughout the United States and its territories. A total of 14,047 facilities responded to the 2005 survey, a response rate of 95 percent.
The 2005 national survey reported that the number and proportion of clients receiving methadone increased from 172,502 (17 percent of all clients) in 2000 to 235,836 in 2005(22 percent of all clients). It also indicated that opioid treatment programs, which focus on treating addiction to heroin and prescription narcotic pain medications, were available in 8 percent of all substance abuse treatment programs.
N-SSATS, a snapshot of the substance abuse treatment delivery system, helps SAMHSA and state and local governments assess the nature and extent of services provided in state-supported and other treatment facilities, and forecast treatment resource requirements. The date of March 31 is used a reference point because it is when survey participants report on the number of clients in treatment.
N-SSATS is also used to update SAMHSA's Substance Abuse Treatment Facility
Locator, available at http://findtreatment.samhsa.gov. The locator service provides the phone numbers and locations of the nearest state-approved treatment facilities.
From a December 8 SAMHSA press release:
SAMHSA today announced the availability of fiscal year 2007 funds for grants to support statewide consumer networks that will enable persons affected by mental illness to participate more fully in state and community planning and policy making affecting mental health treatment, rehabilitation and support services to reorient the focus to recovery.
It is expected that $626,000 will be available to fund nine grants of $70,000 each for Statewide Consumer Network Grants that will continue for a total of three years. The grants are meant to enhance capacity and infrastructure at the state level to be consumer-centered and targeted toward recovery and resiliency. These grants will also provide consumers of mental health services with the tools they need to strengthen coalitions among consumers, policymakers and service providers, recognizing that consumers are the best and most effective transformation and change agents.
WHO CAN APPLY: Eligible applicants include domestic, public and private nonprofit entities, including faith-based organizations, tribal organizations; and currently funded Statewide Consumer Network grantees.
HOW TO APPLY: Applications for SM-07-002 are available by calling SAMHS's Clearinghouse at 1-877-SAMHSA7 [TDD 1 800-487-4889]. You may request a complete application kit from the SAMHSA Web site www.samhsa.gov/grants/index.aspx or www.grants.gov.
APPLICATION DUE DATE: Application must be received by February 1, 2007.
ADDITIONAL INFORMATION: Applicants with questions on program issues should contact Wanda Finch at 240-276-1916 or wanda.finch@samhsa.hhs.gov. For questions on grants management issues, contact Kimberly Pendleton at 240-276-1421 or kimberly.pendleton@samhsa.hhs.gov.
From a December 8 SAMHSA press release:
From a December 11 SAMHSA press release:
New Science to Service Awards Will Honor Implementation of Evidence-Based Mental Health and Substance Abuse InterventionsSAMHSA has issued a call for applications for its Science to Service Awards, a new national program that will recognize community-based organizations and coalitions that have shown exemplary implementation of evidence-based mental health and substance abuse interventions. The new awards program, which is part of SAMHSA's mission to build resilience and facilitate recovery, will recognize and promote the rapid implementation of effective, evidence-based interventions that benefit consumers and communities.
A maximum of three awards will be made in each of four categories: substance abuse prevention, treatment of substance abuse and recovery support services, mental health promotion, and treatment of mental illness and recovery support services. To be eligible for an award, an organization must have successfully implemented a recognized evidence-based intervention, including those that are published in scientific literature and/or appear on a Federal and/or state registry of evidence-based intervention.
Both public sector (State, local territorial, tribal) and private sector organizations (including community-based organizations and/or coalitions) are eligible to compete for the awards. Developers of an evidence-based intervention, or their research collaborators, and Federal agencies are not eligible for the awards.
A total of four review panels will be convened, one in each of the four eligibility areas noted above. Each review panel will consist of seven national experts in the category, and will include representatives from key national organizations. All applications will be rated using the following four criteria: community need, sustainability, implementation, and results. Review panels will recommend for an award the top three scoring submissions in each of the four categories. SAMHSA's Office of the Administrator and the agency's Center Directors will review and approve award finalists. Finalists may also receive a site visit from one or more reviewers prior to the announcement of the award recipients. Submission of an application or selection as an award winner is not associated with any other current or future funding from SAMHSA or any other Federal agency. Complete information is available on the SAMHSA Web site at http://www.samhsa.gov/Spotlights/sciencetoservice.pdf.
Applications must be emailed by February 28, 2007 to dfixsen@fmhi.usf.edu. For community organizations without access to email, the application must be postmarked by midnight on February 28, 2007 and mailed to Dean Fixsen, Ph.D., Science to Service Award Coordinator, University of South Florida, 13301 Bruce B. Downs Blvd., MHC 2312, Tampa, Florida 33612.
From a December 8 SAMHSA press release:
CMS Publishes Final Patient's Rights Rule On Use Of Restraints And Seclusion
Health care workers who employ physical restraints and seclusion when treating patients must undergo new, more rigorous training to assure the appropriateness of the treatment and to protect patient rights, according to a regulation published in the Federal Register today by the Centers for Medicare & Medicaid Services (CMS).
The patients' rights regulations set forth, as a condition of participation (CoP) in the Medicare and Medicaid programs, the expectation that health care facilities will protect the rights of patients. These protections are part of Medicare's revised CoP requirements that hospitals must meet. The requirements apply to all participating hospitals including short-term, psychiatric, rehabilitation, long-term, children's and alcohol/drug treatment facilities.
"Through this regulation, CMS will hold all hospitals accountable for the appropriate use of restraint and seclusion," said Leslie V. Norwalk, acting administrator of CMS. "Today's action reinforces this administration's commitment to patient safety and the delivery of high quality health care services."
"These new rules demonstrate our commitment to advancing patient safety and patient rights in health care facilities," said Eric B. Broderick, D.D.S., M.P.H., Acting Deputy Administration at HHS' Substance Abuse and Mental Health Services Administration. "Today we are taking needed steps to solidify training requirements and essential reporting to reduce and ultimately eliminate seclusion and restraints."
To address concerns about the improper use of restraints and seclusion and in response to the 4,000 public comments received on the interim final rule, the final regulation strengthens the staff training standard and specifies components of the training. The rule also expands the category of practitioners who may conduct patient evaluations when a restraint or seclusion tactic has been implemented.
CMS currently requires that a patient be evaluated "face-to-face" within an hour of a patient being restrained or secluded for the management of violent or self-destructive behavior. Prior to this rule, these actions had to be reviewed within that hour by a physician or "other licensed independent practitioner (LIP)." Today's action expands that list to include a trained registered nurse (RN) or physician assistant (PA). The rule requires, however, that when an RN or PA performs the 1-hour-rule evaluation, the physician or other LIP treating that patient be consulted as soon as possible.
The basic rights specified in the regulation include a patient's right to notification of his or her rights in regard to their care, privacy and safety, confidentiality of their records, and freedom from the inappropriate use of all restraints and seclusion, in all hospital settings.
In the development of this final rule, CMS has been sensitive and responsive to the comments of the provider communities, protection and advocacy associations, private citizens, and the health care community in general. The intent of this regulation is to ensure the protection of each patient's physical and emotional health and safety. In this final rule, CMS has addressed public comments without compromising these protections.
Under the new regulations, hospitals must provide the patient or family member with a formal notice of their rights at the time of admission. These rights include freedom from restraints and seclusion in any form when used as a means of coercion, discipline, convenience for the staff, or retaliation.
Stricter standards for when a healthcare facility must report the death of a patient associated with the use of restraints and seclusion have also been adopted with this rule.
The regulation is in today's Federal Register and will become effective on February 06, 2007. It can be found at www.cms.hhs.gov.
