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Mental Health Association in North Carolina
Public
Policy Update
April
20, 2009
In this
issue:
Budget
Update
Preferred
Drug List/Medication Access
Parental
and Student Involvement Bill H 218(School Suspension Notification)
New DMA
Director
New
Appointments at DHHS, State Operated Services Director New plans for
CRH, Dix and CRH/JUH adolescent units
Budget
Update: The Senate Appropriations Committee voted out
their version of the budget on Tuesday and the Full Senate is
expected to vote on it on Wednesday and Thursday and send it off to
the House. Discussion, including the introduction of amendments was
limited and the bill itself has been crafted mainly outside of the
public view. The Senate made few changes in the MH/DD/SA and Medicaid
portions of the budget from the one introduced by the Governor. Among
the changes is the elimination of 12 million in funds for
376 unidentified vacant positions and freezing the inflationary
increases for many community Medicaid providers. Items included from
the Governor's budget are the closure of Wright and Whittaker
Schools, the closure of two 25 bed units in the state psychiatric
hospitals, and 100 million in "savings" (i.e. cuts) in
Medicaid services, some of which will come from personal care
services, community support group hours, and medications. To achieve
these savings, including 30 million in drug cost reductions, NC DHHS
is given broad discretion to use cost management tools like prior
authorization and the development of preferred drug lists for all
drug classes, including mental health medications. Twelve million is
included for the expansion of community hospital beds, 3 million for
the continuation of the Dix unit of Central Regional Hospital, 2.5
million to expand cross area service programs for addiction treatment
and prevention, and 1 million for youth substance abuse prevention
and chronic disease prevention planning. The Senate budget makes 2
billion in cuts to the overall budget, but it also rests on more than
500 million in revenue increases that have yet to be identified. In
an unusual move, the Senate Finance committee may take up a revenue
bill next week, following the passage of the budget bill.
The state of North Carolina continues to face a difficult economic
and revenue situation. Unlike the Federal budget, North Carolina must
enact a budget that balances out its revenues (taxes, fees, receipts,
etc) with its spending plan. MHANC commends the Governor and the
Senate for sparing major cuts to the Division of MH/DD/SAS seen in
previous budget crises. As advocates for people with mental
illness, we continue to oppose policies outlined in the budget
and those related budget cuts that would negatively
impact people with mental illness. As stated in our last
update, before services delivered at Wright and Whittaker schools are
closed the state must take a hard look at the quality and type of
services these children and others like them need and determine if
they are available across the state. These programs deliver high
quality services to children who have not been able to succeed in
other settings, including their schools, other treatment programs and
at home. We believe that all children with emotional and behavioral
disorders deserve the chance to succeed at home, in schools and in
their communities.
For a list of Senate budget items related to mental health, see the
end of this report. A larger list of Senate budget items impacting
health, human services, justice, public safety, education, and people
with disabilities see the MHANC website at http://www.mha-nc.org and click on the
"Advocacy" tab. To view the full Senate Budget go to http://www.ncleg.net (see left hand
column).
Preferred
Drug List/Medication Access: The Senate budget
includes an expected 30 million in "savings" to Medicaid
drug costs. Medicaid hopes to find 30 million in
savings from enhanced utilization management techniques and
increasing rebate collections on generic drugs, but if it does not,
the budget authorizes a preferred drug list for ALL classes of
medications including those for treatment of mental illness. MHANC
has for a long time opposed preferred drug lists, prior
authorization, and other drug management efforts when they are
applied to medications that treat mental illnesses. Despite how far
we have come in research for treatment of disease, we still lag
behind in a variety of effective treatments for mental illness
compared to those available for physical illnesses. Until we have the
wide array of effective treatments for mental illness that we have
for heart disease, infections, etc., we need to enact policies that
allow for the most flexibility in treating individuals. We need
medication policies that prevent inappropriate use, allow for
individuals to have informed choices, and recognize the vast
difference between treating mental illness and treating illnesses
like high cholesterol or acid reflux. Even the Federal government in
their Medicare drug plan recognizes that Medicare insurance plans
must cover virtually all drugs for the treatment of mental illness;
we expect North Carolina should recognize the importance of these
medications to reducing crisis, hospitalization and inpatient
services and exempt mental health medications from a PDL.
Parental
and Student Involvement Bill H 218 (School Suspension Notification):
House Bill 218, The Parent and Student Educational Involvement Act
passed third reading in the House on Thursday and now moves over to
the Senate for consideration. This bill requires schools to notify
the legal guardian of the child when that child is recommended for
expulsion or suspension of more than 10 days. The notice must now
include information about the reasons for expulsion/suspension and
the students/parents rights to request a hearing, the time frame for
doing so and other information about the school board's hearing
process.
New DMA
Director: The NC DHHS has announced the appointment
of Dr. Craigan Gray to oversee the state's Medicaid program. Dr. Gray
is currently vice president of medical affairs and chief medical
officer at the Bon Secours Our Lady of Bellefonte Hospital in
Ashland, Ky. He was chairman and managing director of Employee
Benefit Trust in Asheville from 1995-2002 as well as a physician and
medical community leader at Mission/St. Joseph's Hospitals. In
1975, he co-founded and was the senior managing physician of
Asheville Women's Medical Center. Dr Gray will oversee the NC
Division of Medical Assistance with a 11.3 billion dollar budget (2.9
in state funds) which serves 1.7 million adults and children in NC
and funds more than half of the mental health services delivered to
individuals in the state. To read the announcement from DHHS on his
appointment go to http://www.dhhs.state.nc.us/pressrel/2009/2009-3-26-medicaiddirector.htm
New
Appointments in DHHS: Dept Secretary Lanier Cansler
has announced several appointments as part of his efforts to improve
state hospital administration and quality assurance statewide. J.
Luckey Welsh Jr., former president and CEO at Southeastern Regional
Medical Center in Lumberton, will serve as director of the state's
Mental Health, Developmental Disabilities, and Substance Abuse state
operated facilities (hospitals, DD centers, ADATCs, neuro-medical
centers). Cecelia Karas, a former mental health consultant with
a reputation for quality service, will direct Health and Human
Services Training and Quality Assurance Initiative.
To read the announcement from DHHS on these
appointments go to http://www.dhhs.state.nc.us/pressrel/2009/2009-3-24-mhddsasappointees.htm
New
plans for CRH, Dix and CRH/JUH adolescent units: Secretary
Cansler announced a new plan for several state hospital units.
Adolescents now served at the former John Umstead Hospital will
served at both the new Central Regional Hospital and at programs in
the Dix unit of CRH. Space at JUH will be utilized for CRH offices.
Forensic patients will continue to be served on the Dix campus, and
high risk forensic patients will be served at CRH. These changes are
dependent on the lifting of a judges order that prevents the transfer
of Dix patients to CRH. The 60 bed unit at the Dix campus, a
collaboration between Wake County and the state of NC, will continue
to operate. To read the announcement on these changes to the state
facilities go to http://www.dhhs.state.nc.us/pressrel/2009/2009-4-9-centralplan.htm
Summary
of Senate Budget items:
Click to view the PDF of
Senate Budget Summary
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