May 2005 NACBHDD Newsletter
The monthly newsletter for the National Association of County Behavioral Health and Developmental Disabilities Directors
In this Issue...
The 2005 NACBHDD Newsletter series is brought to you by:
NACBHD Annual Meeting: Mark Your Calendars for October 20-22
The NACBHD Annual Meeting will take place October 20-22 in Portland, Oregon. Please take a moment to mark this important meeting on your calendar, and check the website for more information on the meeting and for instructions on registering online.
NACBHD Board Meeting Scheduled for July
The NACBHD Board Meeting is scheduled for July. Look for a report on the Board Meeting in the August newsletter.
Medicaid Update
The most recent information about Congressional activity around Medicaid can be found in the April 29 Washington, D.C. Update and a May 2 Medicaid and the Budget Update from Andrew Sperling of NAMI. Both documents have already been sent to members electronically. In summary, the Senate Finance Committee and the House Energy and Commerce Committees will have to find $10 billion in savings (most likely from Medicaid) as part of the reconciliation process by September 2005. A bipartisan commission on Medicaid Reform is under development, and Congress is communicating concerns to HHS Secretary Leavitt about the composition and responsibilities of the commission. However, the Administration has made determinations about the Commission (e.g. function and processes). Information regarding the Commission can be found at: http://rs6.net/tn.jsp?t=xeudjhbab.0.jmpvshbab.b9b95sn6.4318&p=http%3A%2F%2Fwww.cms.hhs.gov%2Ffaca%2Fmc%2Ffrnotice.pdf. NACBHD will continue to keep members apprised of developments in Medicaid reform and in the budget cuts through the newsletter and Washington Updates. To read the April 29 Washington, D.C. Update, click here. To view the May 2 Medicaid and the Budget Update, click here. To view letters communicating concerns about the Medicaid Reform Commission, click here.
Medicare Update
The most recent information about activity around the January l, 2006 implementation of the Medicare Modernization Act of 2003 can be found in the April 29 Washington, D.C. Update. NACBHD and other advocates recently met with the new CMS Ombudsman to discuss the needs of the dually diagnosed during the transition. To read the April 29 Washington, D.C. Update, click here.
CMS and SSA Notices About Drug Plans to Go Out Soon to Low Income Beneficiaries
CMS has informed NACBHD that it will soon mail notices to deemed eligible beneficiaries who are automatically eligible for the limited income subsidy for the Medicare Prescription Drug Benefit (dually eligible). And, throughout the summer, the Social Security Administration will mail letters and applications to people who will not automatically receive help but may be eligible.
Notices for those automatically eligible
In late May, CMS will mail the notice "Important Information from Medicare about Paying for Prescription Drugs" to over seven million people. Three versions of the notice will be distributed: 1) a notice for people with Medicare and Medicaid, 2) a notice for people in a Medicare Savings Program (MSP), and 3) a notice for beneficiaries who receive Supplemental Social Security Income (SSI). Copies of these notices can be accessed online at www.cms.hhs.gov/medicarereform/lir.asp
Notices and applications for those who may be eligible
In addition, other people who do not automatically receive the extra help but may be eligible for it, will receive a different letter and application from the Social Security Administration informing them that they can apply for Medicare to pay for the cost of prescription drugs. This letter will be mailed out from the end of May through August.
Beginning July 1, the SSA application will be available online or by phone from the SSA at 1-800-772-1213. See the SSA web site at www.socialsecurity.gov/organizations/medicareoutreach2/.
For information on the new Medicare Prescription Drug program, contact 1-800- MEDICARE (TTY 1-877-486-2048) or www.medicare.gov.
CMS Answers NACBHD Questions
At the February Legislative Conference, NACBHD members had several questions for CMS presenters regarding the Medicare Modernization Act implementation. Lisa Wilson of CMS researched the issues and provided the answers to Melissa Staats. A summary is provided below.
1. Formularies and the appeals process. Who can appeal?
See Subpart M for more information on appeals, particularly the definitions in
Section 423.560 on p. 4562 of the Federal Register version of the final regulation found at
http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/pdf/05-1321.pdf.
If the question is: Who can request an appeal to receive a Part D drug that isn't covered under a plan's formulary?, then it's the enrollee or the enrollee's appointed representative. Appointed representative is anyone the enrollee chooses, or anyone authorized under State or other law. The enrollee's prescribing physician can request a coverage determination or an expedited redetermination (the first appeal) without being the enrollee's appointed representative.
If the question is, Who can challenge a plan's formulary (i.e., what Part D drugs the plan chooses to cover or where those drugs are placed on a formulary?, no one can under Subpart M.
2) Excluded drugs from formularies.
The excluded drugs can be found in 1927(d) of the Social Security Act. These drugs are not "covered part D drugs" but may be provided as a supplement to the covered Part D drugs by a plan. State Medicaid agencies also have the option to cover these drugs.
3) How can CMS ensure that mental health consumer representatives are
involved in MMA oversight?
CMS is researching the answer to this question.
4) Pharmacy Plan Committees. What is the composition? How many are pharmacists?
Refer to pages 4-6 on the http://www.cms.hhs.gov/pdps/FormularyGuidance.pdf website for information about Pharmacy and Therapeutic Committees. They must represent various clinical specialties that adequately represent the plan membership; a majority must be practicing physicians and/or pharmacists; at least one practicing physician and pharmacist must specialize in care for the elderly or disabled; and, at least one physician and pharmacist must be independent and free of conflict with respect to the plan and pharmaceutical manufacturers.
5) Can states receive FFP if they pay for excluded drugs? How will that work?
Yes, they can receive FFP for excluded drugs. They will continue to report it just as they currently do.
Kaiser Commission Releases Medicare Fact Sheets
The Kaiser Family Foundation recently released fact sheets that explain trends in Medicare. The fact sheets, "Medicare at a Glance," "The Medicare Prescription Drug Benefit," "Medicare Spending and Financing," and "Medicare Advantage," can be accessed at www.kff.org.Social Security Update
A recent email communication from the ARC to the Consortium for Citizens with Disabilities advocates highlights the potential loss of Social Security Income for over 200,000 recipients, the majority of which are children and adults with disabilities. A paper from the Center for Budget and Policy Priorities (CBPP) summarizing the impact was attached to the email. To view the CBPP paper, click here.
Housing Update
NAMI, as part of the CCD, has voiced opposition to the restructuring of the Section 8 housing voucher program. Legislation under consideration (S 771/HR 1999) would repeal protections for people living on Social Security Income that insure that they are able to access rental assistance. CCD has prepared a paper detailing the concerns around the legislation, "The State and Local Housing Flexibility Act of 2005." The legislation would redirect vouchers needed by very low income individuals to higher income households. The Technical Assistance Collaborative, Inc. (TAC) has also voiced opposition to the legislation. To view the CCD paper, "Administration's Section 8 Voucher Proposal Closes the Door on People with Disabilities," click here.
Advocacy Updates on Recent Legislation
Mental Health Liaison Group Letter Supports Keeping Families Together Act
The Mental Health Liaison Group (MHLG), of which NACBHD is a member, is sending a letter to Senator Susan Collins (R-ME) and Representative Jim Ramstad (R-MN) in support of the Keeping Families Together Act. The legislation will address the issue of parents having to relinquish custody of their children to the state in order to receive mental health services for them through providing state grants for interagency care for youth with serious mental and emotional disorders and by allowing more children to receive mental health services under Section 1915(c) Medicaid waivers. To view the letter, click here.
Advocates Requested to Support Full Funding of Garrett Lee Smith Memorial Act
Senators Gordon Smith (R-OR), Jack Reed(D-RI), Mike DeWine (R-OH), Chris Dodd (D-CT), and Harry Reid (D_NV) recently sent a letter to colleagues endorsing full funding of the recently enacted Garrett Lee Smith Memorial Act which provides support for youth suicide and early intervention programs, technical assistance centers, and addresses mental health needs on college campuses. Advocates are urged to contact the congressmen in support of full funding of this legislation.
Network of Care: NACBHD Members Continue to Join Innovative Web-Based Network that Promotes Recovery
NACBHD member counties in Maryland, New York, Ohio, and Virginia have now joined the Network of Care, the innovative resource for consumers, families, and agencies, that strives to provide "No Wrong Door" for those seeking information on mental health issues. The site has been recognized by the President's Commission on Mental Health as a model program; and NACBHD and Trilogy Integrated Resources' unprecedented public/private partnership is allowing counties to rapidly meet the goals outlined in the Final Report of the New Freedom Commission on Mental Health. (NACBHD has a goal of having the Network of Care established in every county-sponsored behavioral health and developmental disability authority in the United States over the next two years.) The Network of Care provides information on behavioral health services, laws, and the most current related news, as well as links to services, a library, legislation, insurance, and support and advocacy. Resources can be individualized locally, regionally, and across the behavioral health spectrum.
The following NACBHD member counties have taken advantage of the 25% discount on setup and maintenance (a 50% discount for the first 36 local installations during the first 12 months of the agreement): Worcester County, Maryland; Onondaga County, New York; Ashland, Clermont, Columbiana, Lorain, Stark, and Wayne-Holmes Counties in Ohio, and Charles City, Chesterfield, Henrico, New Kent, and New River Valley Counties in Virginia. The City of Richmond, Virginia has joined as well.
As NACBHD public policy consultant Robert Egnew says, NACBHD is committed to the idea that "information is key to the empowerment and self-determination: essential to recovery for consumers and families.
For more information or to implement the Network of Care in your community
If you have questions about the Network of Care or are interested in implementing it in your county or area, contact Robert Egnew at rcegnew@yahoo.com. For more information about the Network of Care, see www.networkofcare.org.
For more information about Trilogy Integrated Resources, see www.trilogyir.com.
Update on the Campaign for Mental Health Reform
NACBHD spoke with Bill Emmet, project director at the National Association of State Mental Health Program Directors, and project director for the Campaign, about recent Campaign activities.
May 11 Capitol Hill briefing on early intervention and screening. The Campaign's May 11 briefing for Hill staffers on early intervention and screening was a success, says Emmet. He notes that during the Senate briefing the room was full of Senate staffers. The agenda for both houses was the same, and Representatives Kennedy and Napolitano spoke in the House. The briefings emphasized getting accurate information out to both sides of Congress because they will be considering legislation that impacts services for adults and children. Emphasis was placed on the concepts that treatments do work and that there a lot of people in need of services.
The Campaign plans other Hill briefings; topics are yet to be chosen but may include the mental health needs of individuals returning from combat.
For more information on the May 11 briefing and to access the information presented to Hill staffers at the briefing, see www.mentalhealthreform.org.
State-Informed Federal Policy Initiative Call to Action: Release Planned for Late July. The Campaign's project to gather information on state and local transformation efforts and determine the implications for federal policy is in process, with plans to release the final document (not yet formally named) in late July. The report will include a number of proposals for federal action to advance the goals and recommendations of the New Freedom Commission. Congress is the primary audience for the Call to Action, and a briefing or other event is in the planning stages. "We expect that we will have some kind of event around the action report," says Emmet.
Campaign Director The Campaign is close to announcing the hiring of an Executive Director, who Emmet says the Campaign hopes will step up the Campaign efforts to a higher strategic level -- someone with significant Hill experience who can envision and strategize where the Campaign wants to go.
Medicaid The Campaign is watching Congressional activity around Medicaid closely, and remains concerned about the $10 billion in cuts falling disproportionately on those who use mental health services. The March 17 press release from the Campaign reflects the Campaign's concerns about the devastating effect of Medicaid reductions at the local level See www.mhreform.org, "House Medicaid Cuts Devastating for American with Mental Illnesses, Say Advocates," for the press release.
Mentally Ill Offender Treatment and Crime Reduction Act. Emmet notes that the Campaign continues to work on appropriations for this legislation, and that there is some support in both houses for it.
A Local Recovery Success Story Continued: Western Care Coordination's Peer and Family Coordinator Talks with NACBHD
In March, NACBHD spoke with representatives of a program involving local NACBHD member organizations directly involved in a recovery-oriented effort that has been up and running since 2002 - before the Final Report of the President's Commission was issued. Recently, NACBHD had the opportunity to speak with Western Care Coordination's Peer and Family Coordinator, Brian Phillips at length about his experiences and perspective. The Western New York Care Coordination Program involves six New York counties - Monroe, Erie, Genessee, Wyoming, Chautauqua, and Onondaga. Monroe, Chautauqua, and Onondaga are NACBHD member counties.
Phillips' background
Phillips started working in the field after what he characterizes as "a terrible struggle" of his own. From 1996-1998, he was a peer specialist on one of the first ACT teams in New York state. He then worked in rehabilitation services and sheltered work, and later joined a peer organization where he was Coordinator for the Peer Networking Group for a 20 county networking effort. Phillips came to Western Care Coordination in July 2002, where he saw an opportunity to enhance education about recovery and what is needed for recovery.
Challenges to promoting recovery
Phillips experiences gave him perspective on what some of the challenges to recovery might be. One of the biggest challenges is how staff may perceive consumers. Staff members may have previous work experience in inpatient settings, and it may not be easy "to leave the walls behind." And, the well-intentioned concern about responsibility and stress is not necessarily conducive to recovery. Phillips believes that one message the peer movement can communicate is that responsibility is all right, even if it is stressful, and that mistakes will be made, just like in everyday life. However, often there is a well-intentioned attitude in the field that life stresses may cause regression and inhibit recovery. But Phillips notes that if one never encounters stress, one will not be forced to deal with it and learn how to cope with stressful situations. And, he says, as we look at recovery, we need to realize that stress is normal and is part of recovery, just as growth is part of recovery.
What are some of the real ingredients of recovery?
Recovery involves an approach of respect and acknowledgement that the person involved in recovery knows a lot about himself or herself and what they need to recover and what they need as an individual to build connections to the community, explains Phillips. And, once these connections are established, they are often connections that are not subject to cuts, such as the looming Medicaid cuts. Rather, these community connections may be "the stuff of everyday life."
This approach involves mental health organizations looking out into the community, not necessarily building a resource for recovery into the organization, but looking at some community connections that anyone may be involved in. Phillips relates his personal experience with community resources. He found significant resources when he enrolled in a psychology class in his small community college and encountered information he had been struggling to access and understand for eight years.
Recovery in the community
"There are good people everywhere you go. Once someone meets a person and understands them, the stigma goes away," says
Phillips.
Phillips provides two real examples of recovery in the community:
"People will rally if they know what is expected of them." Phillips says the community can be educated about the part they can play and about being receptive to what they can do to help, and he emphasizes the need to look to the strength and goodness of people. However, one concept that needs addressing in communities is the assumption that people with psychiatric disorders are unpredictable and dangerous.
A Peer and Family Coordinator's job description
Phillips' job has its own unique challenges; he is in the position of listening to peers but not advising in a way that prevents someone for learning how to handle situations. While he says he does not feel responsible for individual recoveries, he is there to help people learn from their situations and experiences. Peers call often for advice, but as he says, he "puts it back in their laps to talk about how to handle" situations.
In addition to working individually with peers, Phillips is involved in steering committee meetings, peer and family advocacy meetings, and special initiative meetings. He also meets often with the six local peer advisory groups. The local peer and family groups and the steering committee give feedback to one another, and Phillips is part of trying to keep people informed in both directions in a timely manner. He carries a collective peer voice to meetings, and is grateful that he can bring the peer perspective to significant issues and that the perspective is respected. For example, recently an input form of indicators was utilizing only negative indicators, and he was able to communicate an idea from a peer -- the concept of resiliency indicators.
Phillips enjoys his job and takes it very seriously, especially fostering collaboration in breaking down the barriers between peers and county government. Each county has developed a steering committee with everyone invited to the table - peers, providers, county government officials, and family members. These are positive, productive meetings and an opportunity to understand what is happening at the "ground level."
There is an interface with the local NAMI, whose director is very involved in their program, and is on the peer and family advisory group. Other counties may be working toward this in the coming year, since families are so important to recovery, but Phillips acknowledges the very practical difficulty of family involvement in some of the program meetings. Many of the meetings happen between 9 and 5 when family members are working.
The peer perspective as part of the solution
Phillips emphasized that the peer perspective is part of the solution, but not the whole solution. He cited other components: the value of newer medications, the family perspective, the clinical perspective, the work on the best possible environment for recovery, with all these components encompassed in a concept of recovery as perceived by the individual recovering, rather than the person educated about the diagnosis.
In the near future: a training of the what recovery means
In the upcoming year, Western Care Coordination in collaboration with the New York Association of Psychiatric Rehabilitation Services, will hold a training in recovery and the person-centered approach. People in recovery will discuss recovery and living lives that are meaningful to them.
For more information about peer and family coordination, contact Brian Phillips at bphillips@ccsi.org. For more information on Western Care Coordination, see the April newsletter or the web site at www.carecoordination.org.
Economic Benefits of Drug Treatment: A Critical Review of the Evidence for Policy Makers Outlines Economic Benefits of Treatment
Economic Benefits of Drug Treatment: A Critical Review of the Evidence for Policy Makers
summarizes the economic benefit of treatment and includes information on treatment costs, cost effectiveness analysis, and cost benefit analysis. The report is authored by Steven Belenko, Ph.D., Nicholas Patapis, Psy.D., and Michael T. French, Ph.D. of the University of Pennsylvania's Treatment Research Institute; it can be accessed at
www.tresearch.org/resources/specials/2005Feb_EconomicBenefits.pdf.
SAMHSA News
New Mental Health Transformation Publication Available Online
Mental Health Transformation Trends: A Periodic Briefing is now available online from SAMHSA. According to an April 18 SAMHSA press release, the publication aims "to keep mental health partners up to date on emerging issues, practices and trends as the nation moves toward a recovery-oriented, consumer-driven mental health system." Information in the bi-monthly publication includes:
The publication can be accessed at www.samhsa.gov/matrix_mh.aspx. During the first year of publication, hard copies will be mailed and accompanied by a posting to the SAMHSA website. Thereafter, the publication will convert to an electronic format.
Reminder: Apply For Grants Through www.grants.gov.
From an April 22 SAMHSA press release:
SAMHSA is sending an e-mail letter to persons known to be interested in SAMHSA grants to inform them that they can file for grants online at www.grants.gov.
This new system creates one application process for 26 participating federal departments and agencies. It will enable prospective grantees to register one time for all federal grant opportunities available online and have information generated for future applications, so information does not have to be re-entered.
The grants.gov system will provide immediate electronic notification of grant opportunities and any changes to published announcements. Online and phone assistance is available every business day to provide answers to questions.
SAMHSA allows five days after the grant deadline for mailing signed copies of electronic forms requiring signatures. Interested applicants can see a web cast on grants.gov at www.grants.gov/SpreadWordWebcast.
Updated Nationwide Treatment Facility Locator of Drug, Alcohol Abuse Treatment Programs Now Available
From a May 20 SAMHSA press release:
SAMHSA's online Treatment Facility Locator has been updated and is now available. The locator is a searchable database of more than 11,000 addiction treatment programs around the country that treat alcohol and drug abuse problems. Persons seeking treatment can use the locator to find the treatment facilities nearest them that offer the services they need. A comprehensive set of instructions on how to use the enhanced locator is available in Using the Substance Abuse Treatment Facility Locator.
The locator includes private and public substance abuse treatment facilities that are licensed, certified or otherwise approved for inclusion by their state substance abuse agency in all 50 states, the District of Columbia, the Federated States of Micronesia, Guam, Puerto Rico, the Republic of Palau, and the Virgin Islands. The locator website also includes a list of the state substance abuse agencies, contact information for those agencies and links to their websites. In addition, a link is provided to SAMHSA's Buprenorphine Physician Locator that identifies physicians who are authorized to prescribe buprenorphine by zip code, city, county, or state.
The updated locator complements SAMHSA's National Directory of Drug and Alcohol Abuse Treatment Programs 2005, which is published annually in hard copy. (See below.) To access SAMHSA's Treatment Facility Locator log on the Internet see: http://findtreatment.samhsa.gov. Use the CLICK HERE to go to the locator's home page, which shows a map of the United States, then click on the state or click on "Learn How to Use All the Locator Search Features" above the U.S. Map. The short report, Using the Substance Abuse Treatment Facility Locator, is accessible at www.oas.samhsa.gov.
Directory of Drug, Alcohol Abuse Treatment Programs Available
From a May 3 SAMHSA press release:
SAMHSA's updated guide to finding local substance abuse treatment programs is now available. The guide, National Directory of Drug and Alcohol Abuse Treatment Programs 2005, provides information on thousands of alcohol and drug treatment programs located in all 50 states, the District of Columbia, Puerto Rico, and four U.S. territories. The directory includes public and private facilities that are licensed, certified, or otherwise approved by substance abuse agencies in each of the states. The directory is a nationwide inventory of substance abuse and alcoholism treatment programs and facilities that is organized and presented in a state-by-state format for quick-reference by health care providers, social workers, managed care organizations, and the general public. It provides a listing of more than 11,000 community substance abuse treatment programs, and is designed to quickly provide important information on levels of care and types of facilities, including those with programs for adolescents, persons with co-occurring substance abuse and mental disorders, individuals living with HIV/AIDS, and pregnant women. The 2005 directory identifies both long and short-term residential treatment facilities and facilities that provide residential beds for clients' children.
The updated directory complements SAMHSA's internet-based Substance Abuse Treatment Facility Locator. (See above.) To obtain a free copy of the National Directory of Drug and Alcohol Abuse Treatment Programs 2005, contact SAMHSA's Clearinghouse or call (800) 729-6686.
SAMHSA and FDA Embark on "Do the Right Dose" Campaign Aimed at Older Adults
From a May 5 SAMHSA press release:
Admissions for substance abuse treatment increased by 32 percent among older adults over the eight-year period 1995-2002, concludes a new study released by SAMHSA.
"Older Adults in Substance Abuse Treatment: Update" found that the percent of older adults with opiates as their primary substance of abuse increased from 6.8 percent to 12 percent in this time period. Opiates include prescription pain medications and heroin, and are the second most frequent reason for treatment admissions among older adults, after alcohol.
To counter the upward trend in the abuse of opiates, SAMHSA and FDA are sponsoring new advertisements to encourage older adults to "Do The Right Dose" when using prescription pain relievers.
"We are only beginning to realize the pervasiveness of substance abuse among older adults," SAMHSA Administrator Charles Curie said. "We have made older adults a priority at SAMHSA and we are working to advance understanding of the relationship between aging and substance abuse, and to provide practical information for incorporating our understanding into treatment services. Through the materials we are releasing today, we are reaching out now to older adults to warn them that prescription pain relievers are safe and effective when used correctly, but could lead to abuse and addiction if misused."
"FDA collaborated with SAMHSA to develop these public education materials because our agencies have a shared goal to communicate accurate health information on the proper use of prescription pain medications," said FDA Deputy Commissioner for Operations Dr. Janet Woodcock. "While SAMHSA's data indicate significant growth in opiate abuse, we are just as concerned about those cases of addiction to pain medications that go underdiagnosed. We want to send a clear message to older adults that emphasizes the need to take pain relievers as directed."
The "Do The Right Dose" campaign includes two print ads, one television public service announcement, two radio public service announcements, two posters, and an update of SAMHSA's brochure "As You Age." The campaign will strive to educate older adults that prescription pain medications are safe and effective when used correctly, but if misused, could lead to addiction or other problems.
Alcohol is still the primary substance of abuse among older adults, but the proportion of older admissions reporting alcohol as their primary substance declined from 86.5 percent in 1995 to 77.5 percent in 2002. Drug admissions among those ages 55 and older increased by 106 percent for men and 119 percent for women between 1995 and 2002.
The "Do The Right Dose" campaign also has the support of the Administration on Aging, which works to warn older adults that medicine must be taken appropriately and dosages cannot be altered by patients without consequences.
The report is available on the web at www.oas.samhsa.gov/aging.htm. The "As You Age" brochure is available from SAMHSA's clearinghouse at 1-800-729-6686 or www.ncadi.samhsa.gov. The posters, print Public Service Announcements and other materials are on line at www.asyouage.samhsa.gov/dotherightdose.
