How did Mental Health fare in this year's budget?
Open Access to Medication - a victory, but the jury's still out...
There was a huge threat this year to eliminate the "carve out" to the prior authorization requirements for medicaid funded drugs. In effect, we continue to be an exception to the rule that people must get approval before getting a particular drug. Research indicates that any barrier to getting medications can result in adverse effects, It was all driven of course by money, and a need to balance the state budget in hard times. Many advocates banded together- the grassroots were engaged, and we won! The exemption remains but there will be closer scrutiny to what medications work, and cost with the following requirements:
- The Dept may develop guidelines and measures to ensure appropriate usage of medications, including dosages
- The Dept may require retrospective clinical justification for the use of multiple psychotropics
- For those l8 or under who have 3 or more psychotropics, edits with target inefficient, ineffective, or potentially harmful patterns. When that is identified, a peer to peer consultation will be required
- There will be an emphasis on using the Prescription Advantage List (meds that work and are cost effective) , using more generics, and enhancing rebate collections
Medication committees will adopt policies and procedures on the preferred drugs as follows:
- guidelines for review of drugs for inclusion
- manner and frequency of audits of the list for appropriateness, cost effectiveness
- an appeals process
- all classes of drugs will be included
Additional changes will result if the Department cannot demonstrate by June l, 2010 savings of $25 Million
Peer Support and Community Support
Definitely a good news, bad news report
First, Community support will be ending on or before June 30, 2010. The Division is working hard on discharge planning and transitions, when appropriate, to other services.
The Department shall submit to the federal government revised service definitions that separate case management from the Community Support Definition, and they will submit a new service definition for peer support services for adults with mental illness and/or substance abuse disorders. This is HUGE news- and a very big victory for NAMI NC. This was one of our high priorities on our legislative agenda. It will take a long time to build the infrastructure, but individuals in recovery will be able to have paid positions to help others - particularly as they transition out of corrections, institutions, crises, etc.
Other stipulations:
- no new admissions will be allowed during this transition unless the Department determines appropriate alternate services are not available
- Authorizations currently in effect remain valid
- No CS will be provided in conjunction with other enhanced services (note- it may be used to help with discharge planning for level II I and IV group home transitions for children
- Moratorium continues on endorsing new CS providers
- Paraprofessional level will be eliminated in 60 days of enactment
- 65M in 2010 will be cut 97.5 M in 2011
A stakeholder committee has been established to help with the transitioning of people (14,107 adults, 23,523 children) and NAMI NC is at the table. A subgroup of this group will also help with the review/development of a peer support definition. NAMI NC has facilitated a group working on that task for over a year so all that work will be submitted to the Department.
We are absolutely thrilled to be moving on peer support!!
