July 1, 2008

National Council Resources & Events
Medicaid
Medicare
Addictions
International
Veterans' Mental Health
Criminal/Juvenile Justice
State Watch
Grants & Funding Opportunities
Other Resources
Other Events

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NATIONAL COUNCIL RESOURCES & EVENTS

Report Provides Analysis of Mental Health and Substance Use Disorder Benefits Available Through State Health Care Reform
The National Council for Community Behavioral Healthcare and the National Alliance for Mental Illness (NAMI) recently released a joint report entitled, “Coverage for All: Inclusion of Mental Illness and Substance Use Disorders in State Healthcare Reform Initiatives”. This paper is based on research on 18 state initiatives and proposals and is focused on the mental health and substance use disorder benefits available through state health care reform. Key findings include: 1) Approximately 60% of states evaluated have equal coverage for serious mental illness or mental illness and other conditions; 2) Only 28% of the states evaluated have an equal benefit for substance use disorders and other health conditions in at least one of their programs; 3) Federal waivers are a component of reform in approximately 75% of the states with implemented programs, highlighting the importance of federal dollars and policy in future health care expansion efforts. Both an executive summary and the full report are now available.

Encourage Presidential Candidates to Include Mental Health and Addictions Issues in Health Care Reform
Join 40 national organizations, including the National Council, by signing a petition that calls on the presidential candidates and their parties to make addiction and mental illness part of any national health care reform. The Campaign will deliver the petitions to both major presidential candidates and political party platform committees. Your signature will help demonstrate strong grassroots support for this critical priority.

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MEDICAID

Medicaid Spending Expected to Grow Faster than Overall Spending in State Budgets
According to a midyear survey of state finances released by the National Governor’s Association and the National Association of State Budget Officers, states' revenues and spending growth continue to decline, with growth in Medicaid expect to exceed overall budget increases. The survey found that Medicaid spending accounts for 21.1% of state spending, making it "the single largest portion of total state spending." Medicaid spending in FY 2009 is expected to grow by 4.4%, while state spending nationally is expected to grow by about 1% during the same time period. The survey also found that despite the economic downturn, states and governors are still working to overhaul state health care systems.

Study Finds that Minimal Increases in Medicaid Co-Pays for Prescription Drugs Results in Decreased Utilization
According to a study published in the journal Medical Care, adding even minimal cost-sharing requirements for Medicaid prescription drug plans leads to reductions in utilization by patients with chronic diseases. The article is based on an analysis of the impact of a recent cost-sharing program on medication use by Oregon Medicaid beneficiaries. After adjusting for other factors, overall use of prescription medications fell by about 17% after the initiation of the cost-sharing program.

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MEDICARE

Six Percent of Medicare Providers Have Not Paid Taxes, Still Receiving Reimbursements
According to a Government Accountability Office (GAO) report, more than 27,000 Medicare providers, or 6%, owed back taxes totaling more than $2 billion in 2006, but they are still receiving full payments from the program. GAO found that $896 million, or about half, of the back taxes were from payroll taxes the providers withheld from employees but did not turn over to the Treasury Department. According to the report, $581 million of the owed money was from individual income taxes. The report also found that some nursing homes that owed taxes also had health and safety violations or did not have necessary licensing. Based on these findings, the GAO provides recommendations to CMS including adoption of the Federal Payment Levy Program which would allow the IRS to withhold Medicare payments to providers until the back taxes are paid.

Source: Kaiser Daily Health Policy Report

Medicare National Provider Identifier Update, Troubleshooting
As of 5/23/08, the National Provider Identifier (NPI) became mandatory on all HIPAA claims transactions and on Medicare paper transactions as well. For some of the relatively few claims which continue to reject, CMS has determined that some of the reasons are related to the following issues identified for Part B claims: 1)  The Employer Identification Number (EIN) or Social Security Number (SSN) being submitted in the 2010AA / REF02 (Billing Provider Secondary Identifier), 2010AB / REF02 (Pay to Provider Secondary Identifier) and/or 2310B / REF02 (Rendering Provider Secondary Identifier) of the Medicare X12N 837P transaction does not match the TIN information on the Medicare crosswalk. 2) EIN or SSN being submitted in the 2010AA / REF02, 2010AB / REF02 and/or 2310B / REF02 of the Medicare X12N 837P transaction does not match the TIN information on the Medicare crosswalk. 3)  The Medicare legacy provider identifier is being submitted in the primary and/or secondary provider loops.  Medicare providers should review this list and take appropriate actions to resolve problems they may be experiencing. Providers may also want to consult their clearinghouses or software vendors for additional advice to solve the issues listed in this message. 

Source: CMS email

CMS Releases Guidance on CPT Codes for Psychological and Neuropsychological Tests
CMS announced the release of eight questions and answers on psychological and neuropsychological tests that are billed under the CPT code range 96101-96125.  These Frequently Asked Questions (FAQs) provide clarification on Medicare billing and payment policy for these testing codes when performed by technicians, computers, physicians, clinical psychologists, independently practicing psychologists and other eligible qualified nonphysician practitioners.  The scenarios under the FAQs also address situations where more than one of these testing codes can be billed for services furnished to the same patient.

Medicare Advantage Plans Made Profits Over $1 Billion than Projections in 2005
A Government Accountability Office (GAO) report found that private insurers participating in the Medicare Advantage program in 2005 spent less on medical services for beneficiaries and recorded larger profits than projected. For the report, GAO officials examined the 2005 data from 120 forms submitted in 2007 that chronicle the previous two years, which plans are required to submit for each contract. The plans on average projected spending 90.2% of total revenue on medical services but actually spent 85.7%. The disparity resulted in an extra $1.14 billion in profits. Under the rules of the program, insurers recording more profits than expected are required to spend the additional funds on extra health services for beneficiaries. CMS officials said the findings do not accurately reflect benefits spending versus profits after 2005, when the accuracy of spending projections improved under a competitive-bidding process launched in 2006.

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ADDICTIONS

NIAAA Publishes Guidelines on Alcohol Screening in Primary Care
The National Institute of Alcohol Abuse and Alcoholism (NIAAA) has recently published advice for physicians interested in conducting alcohol screening. The guidelines include simple steps for screening patients for excessive alcohol use and is targeted to heavy drinkers that may not be addicted but are at risk of becoming dependent.  Recommended screening consists of a single question; For men: How many days in the past year have you had five or more drinks? For women: How many days in the past year have you had four or more drinks?

Source: Join Together

Research Indicates that Adolescent Drinkers & Drug Users Die Younger
According to new research from the University of Pittsburg, adolescent substance-abuse disorders are a predictor of young-adult mortality. The study found that young adult males with substance-abuse disorders had a mortality rate far in excess of the norm for their non-addicted contemporaries. For example, 2 percent of the adolescents studied had died by the time the eight-year study period ended, including 23 percent of the African-American males in the study. The study was published in the Journal of Adolescent Health. An abstract is available online.

Potential Vice-Presidential Candidate Calls for New Approach to Addictions Policy
During a hearing of the Joint Economic Committee, Senator Jim Webb (D-VA) called for large-scale reform of the U.S.’ national drug control policy. "Despite the number of people we have arrested, the illegal drug industry and the flow of drugs to our citizens remain undiminished," Webb said during a hearing of the Joint Economic Committee. The hearing featured testimony from a number of witnesses who said that the current enforcement- and incarceration-oriented approach to drug policy has been expensive and ineffective. Webb, who’s name is mentioned as a potential running mate for Barack Obama, said that more treatment alternatives to prison should be considered.

Legal Action Center Resource on Provider Confidentiality Training
Most health care providers must comply with the federal confidentiality regulations specific to alcohol and drug programs (42 C.F.R. Part 2). The Legal Action Center (LAC) now has a DVD, “Confidentiality Training Series: A Guide to the Federal Drug and Alcohol Confidentiality Regulations”, which provides detailed information on how to comply. The series consists of three segments designed to explain both the basic requirements of 42 C.F.R. Part 2 and discuss the nine exceptions to the non-disclosure rules. All DVDs can be purchased individually for $84.95; as an introductory set for $149.95 (Discs 1& 2); or $174.95 for all three. Trainings are also available for purchase on VHS.

Study Finds that Young Amphetamine Users are Much More Likely to Suffer Heart Attacks
According to a study published in the journal Drug and Alcohol Dependence, Amphetamine users are 61 percent more likely to suffer heart attacks than nonusers. The study involved more than 3 million 18- to 44-year-olds hospitalized in Texas between 2000 and 2003. The researchers found that admissions for amphetamine-related heart attacks rose 166 percent during the study period.

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INTERNATIONAL

Study Estimates the Cost to Society of One Individual Addicted to Drugs
A report from accounting firm PricewaterhouseCoopers estimated that each individual with a drug addiction in the U.K. costs taxpayers £800,000 -- about $1.569 million – over his or her lifetime. The estimate included the cost of crime, healthcare under Great Britain's National Health Service, and other considerations; however, researchers said that the estimate was probably on the conservative side. The report said that the cost to society could be reduced to under £70,000 (about $137,000) if people with addiction problems received treatment prior to age 21.

Source: Join Together

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VETERANS' MENTAL HEALTH

Column Highlights Importance of Meeting the Mental Health Needs of Veterans
A New York Times columnist, Bob Herbert, recently stated that "never before has such a strain been placed on the all-volunteer military," adding that brain injuries and mental health issues "are not even being talked about enough, much less dealt with adequately." These wounds are "as real as a bullet or a shrapnel wound," although "not always as obvious," Herbert writes. He continues, "However one feels about the nation's war policies, we have an ironclad obligation to look out for the short- and long-term needs of the troops we send off to combat," adding, "In the absence of any general call for sacrifice, it's the least we can do," however, "Right now we're not even doing that".

Source: Kaiser Daily Health Policy Report

Despite Inadequate Treatment for PTSD, Federal Judge Finds No “Systematic Violations”
U.S. District Judge Samuel Conti on Wednesday dismissed a lawsuit that sought to force changes to the Department of Veterans Affairs' health care system. The lawsuit was filed by two groups, the Veterans for Common Sense and the Veterans United for Truth, in a federal court in San Francisco. Lawyers for the two veterans groups said that staff shortages, long waits, inadequate care and an adversarial appeals process for denied care have created an "epidemic of suicides" among veterans. The lawsuit also says that VA is ignoring or delaying treatment of post-traumatic stress disorder for as many as 750,000 war veterans. In his ruling, Conti agreed with the veterans groups claims that there is a high veteran suicide and PSTD rate; that the VA is understaffed; and that there are long waiting periods for hearing veterans' appeals of benefit denials. In addition, Conti found that members of the two groups "have faced significant delays in receiving disability benefits and medical care from the VA," often with "dire consequences." However, he noted that a majority of veterans are being seen within 30 days. He added that although the delays were "significant," they did not violate a veteran's right to due process because there was no consensus on what "timely" processing would be (Chong, Los Angeles Times, 6/26). According to Conti, while federal law entitles veterans to five years of VA care after they are discharged, "it is beyond the power of this court to determine when and how such care shall be provided."

Source: Kaiser Daily Health Policy Report

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CRIMINAL/JUVENILE JUSTICE

Supreme Court Rules that Individuals with Mental Illness Ruled Competent to Stand Trial May Not be Competent to Represent Themselves
By a 7-2 ruling, the Supreme Court stated that judges may “take realistic account of the particular defendant’s mental capacities” and, in the interest of achieving a fair trial, deny the constitutional right to self-representation that criminal defendants ordinarily enjoy. Justice Breyer said that rather than setting an all-encompassing definition of competency, the court would leave the decision to individual trial judges, who he said “will often prove best able to make more fine-tuned mental capacity decisions, tailored to the individual circumstances of a particular defendant.”

Source: New York Times
 
Publication: Improving Law Enforcement’s Response to Individuals with Mental Illness
The Council of State Governments Justice Center released a new publication, “Improving Responses to People with Mental Illnesses: The Essential Elements of a Specialized Law Enforcement–Based Response”. This resource is a practical handbook on implementing effective training strategies; a monograph on tailoring law enforcement responses to the unique needs of a jurisdiction, which will include specific examples from the field; and web-based information on statewide efforts to coordinate these law enforcement responses. Also available is an online database, the Criminal Justice/Mental Health Information Network, which includes profiles of local law enforcement responses to people with mental illnesses.

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STATE WATCH

FL: Commission Finds that More Deaths Are Occurring Due to Prescription Drugs Rather than Illicit Drugs
The Florida Medical Examiners Commission says that autopsies show that prescription drugs kill three times more people in Florida than all illicit drugs combined. Of the 168,900 deaths examined, legal opioids like Vicodin and OxyContin caused 2,328. Benzodizepines like Valium and Xanax caused 743 deaths. Illicit drugs caused 989 deaths. Alcohol was present in the bodies of 4,179 of the dead, and alcohol was considered the cause of death in 466 cases, compared to 843 deaths caused by cocaine, 25 deaths attributed to methamphetamine, and no deaths attributed to marijuana.

Source: Join Together

FL: New State Law Restores Civil Rights to Individuals Released from Prison
More than 115,000 individuals who have completed their sentences have had their civil rights restored since a new state rule went into effect 14 months ago. This rule, which restores rights almost automatically, ends a policy of requiring the Board of Executive Clemency to act individually on each case. Before this law, Florida was among a few states that refused to automatically restore felons' rights after they completed their sentences.

Source: Stateline

CA: State Officials Seek to Increase Addiction Treatment Opportunities to Reduce Prisoner Overcrowding
California corrections system, advocates, prisoners, state officials and others are working with court appointed referees to develop a solution to the current problem of prisoner overcrowding in the state. With the goal of substantially reducing the prisoner population in the next three years, the plan calls for placing parole violators in treatment programs instead of returning them to prison; having some low-risk offenders serve their time in county jail or on probation; electronic monitoring; and offering reduced sentences to inmates who complete drug treatment, vocational training and educational programs.

Source: Join Together

OH: Newspaper Examines Issues Contributing to Uninsured Rate
According to an analysis by the Akron Beacon Journal, lapses in health insurance, pre-existing conditions and chronic illnesses are contributing to Ohio's uninsured rate. According to the article, 1.4 million, or about one in eight, people in the state are uninsured and 56% of Ohio residents have a chronic health condition. The state's Healthcare Coverage Initiative -- a task force developed by Gov. Ted Strickland (D) -- will soon release recommendations that aim to address the issues. The recommendations are expected to include a health care coverage mandate for individuals ages 19 to 29; requiring insurers to offer coverage to everyone, regardless of pre-existing conditions; extending COBRA benefits beyond the current 18 months; and helping small businesses offer employer-sponsored health coverage.

Source: Kaiser Daily Health Policy Report

NJ: Legislature Approves Bill to Expand FamilyCare Program, Governor Expected to Sign Into Law
The New Jersey Legislature approved legislation that would expand health care coverage for parents and mandate that all children have coverage. The bill would require all uninsured children in the state to obtain private or state-funded health coverage within the first year of the bill's enactment. The plan is expected to begin in September. The program also will expand NJ FamilyCare, the state's version of SCHIP, to parents with incomes up to 200% of the federal poverty level. State Sen. Joseph Vitale (D), the bill's sponsor, said he expects 25,000 parents to enroll in the expanded program within a year and as many as 80,000 to enroll within three years. The plan would be funded with $8.9 million that has already been added to the state's proposed fiscal year 2009 budget.

Source: Kaiser Daily Health Policy Report

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GRANTS & FUNDING OPPORTUNITIES

RWJF and the Center for Creative Leadership Offer the Community Health Leaders Program
The Robert Wood Johnson Foundation (RWJF) and the Center for Creative Leadership have launched the Ladder to Leadership: Developing the Next Generation of Community Health Leaders, a project designed to improve the leadership capacity of community-based nonprofits serving vulnerable populations. Nine priority communities nationally will be targeted by the Ladder to Leadership program, which will provide a 16-month leadership-development curriculum to 270 early- to mid-career professionals. Up to 30 fellows will be chosen from each communities based on their record of accomplishment, future leadership potential, and proven commitment to serving vulnerable populations and improving health outcomes. To learn more and to apply, visit the RWJF website.

State Supreme Court Justices Invited to Apply to the Criminal Justice/Mental Health Leadership Initiative
The Council of State Governments Justice Center invites state supreme court chief justices to submit an application to participate in the Chief Justices’ Criminal Justice/Mental Health Leadership Initiative. Selected chief justices will receive technical assistance and a small amount of funding support as they convene a collaborate task force of state leaders to develop concrete strategies for improving outcomes for people with mental illnesses involved with the criminal justice system. The deadline for applications is July 11.

Mental Health Drug Courts Invited to Participate in Dissertation Research
Kathi Trawver, former program director of the Anchorage Mental Health Court and doctoral candidate at the University of Texas at Austin, School of Social Work, is recruiting mental health courts to participate in her dissertation research to inform mental health court policy and program development, “Who Succeeds in Mental Health Courts? Identifying Predictors Related to Participant Success.” Interested individuals should contact Kathi directly at (907) 786-6915 or afkrt@uaa.alaska.edu.

The Herb Block Foundation Offers Non-Discrimination Grants to Non-Profits
The Herb Block Foundation will make grants of $5,000 to $25,000 for projects aimed at eliminating all forms of prejudice and discrimination. The Defending Basic Freedoms grants are available to 501(c)3 nonprofits; joint projects by two or more organizations are encouraged. The application deadline is October 6.

Open Society Institute Announces a Criminal Justice Fund
As part of a recent commitment of $75 million, the Open Society Institute (OSI) has created a new Criminal Justice Fund. The goal of the expanded U.S. program at OSI will be to promote equality, ensure government transparency, and reform criminal-justice and national-security policies. New, three-year program initiatives announced by OSI include Black Male Achievement, which will work to confront stigmatization, criminalization, and exclusion of African-American men and boys from the economic and political mainstream; and National Security and Human Rights, focusing on U.S. policies on torture, surveillance, arbitrary detention, and racial profiling. You can learn more by visiting OSI’s website.

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OTHER RESOURCES

Study Projects 10% Increase in Employer Health Insurance Costs for ’08 and ‘09
A PricewaterhouseCoopers study projects that employer health care costs will increase by 9.9% in 2008 and 9.6% in 2009. This study, which surveyed more than 500 employers and health plans covering more than 11 million U.S. residents, reported two factors driving the increase: hospital building, including replacement of facilities and creation of outpatient treatment centers; and an increase in expenses for insured residents to offset the cost of the uninsured. According to the report, cost shifting due to the uninsured, Medicare and Medicaid will account for one in every five dollars spent by private insurers in 2009.

Source: Kaiser Daily Health Policy Report

Report Finds Individuals with Mental Illness Wait Longer in EDs as Hospitals Close Psychiatric Units
A report released by the American College of Emergency Physicians (ACEP) found that nearly 80% of hospitals said mentally ill patients who need to be hospitalized sometimes must wait four hours or longer to be admitted because of a shortage of psychiatric beds and mental health staff. By comparison, 30% of hospitals said patients not seeking mental health services had to wait four hours or more before being admitted. The study, which surveyed 328 emergency medical directors, also found that about 10% of the directors said psychiatric patients wait more than one day on average and that 61% of hospitals surveyed do not have psychiatric staff caring for ED patients while they wait, but those patients do receive care for other medical problems. According to ACEP, the number of psychiatric beds in U.S. community hospitals has declined 12% since 2000, compared to a 4% decline in overall hospital beds.

Source: Kaiser Daily Health Policy Report

Government Report Finds that Most Doctors Aren’t Using EMRs, Despite Benefits
According to a government-sponsored survey of doctors, most physicians are not using electronic medical records (EMRs), despite well-known benefits of their use. Of those that used EMRs, responders overwhelmingly said that EMRs improved the quality and timeliness of services. However, most doctors in small practices are unable to afford adoption of EMRs. The study found that 9% of small practices of one to three doctors use EMRs, where nearly half of the country’s doctors practice.

Source: New York Times

KFF Health Insurance Chartbook Available Online, Information on the Uninsured
The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured has been producing annual chartbooks on the uninsured population and health coverage for nearly a decade, examining how many Americans lack coverage, who the uninsured are and how health insurance coverage is changing. This year, the “Health Insurance Coverage in America” chartbook has been reformatted as a web-based information resource including charts and tables to provide a more comprehensive profile of the uninsured population and health insurance coverage more generally.

Families USA Report Features City-Level Health Care Reform Initiatives
In a recently-released report, Families USA looks at how cities are involved in health care issues – through organizing, funding, and delivery of services – and how the rising cost of health care, combined with the growing number of uninsured, has hit municipalities especially hard.

New York Times Article Examines Use of Antipsychotics in Nursing Homes
In a recent article, the New York Times examines the use of antipsychotics among nursing home residents to lessen "the agitation, combative behavior and outbursts" of dementia patients. Sales of newer antipsychotics -- including Risperdal, Seroquel and Zyprexa -- increased from $4 billion in 2000 to $13.1 billion in 2007. According to the Times, the increase in part can be attributed to prescriptions at nursing homes. Researchers estimate that about one-third of all nursing home patients have been given antipsychotics. The Times reports that because many nursing homes are short-staffed and insurers do not generally pay for the "attentive medical care and hands-on psychosocial therapy that advocates recommend," it is "much easier" to use sedatives and antipsychotics on patients with dementia. According to the Times, many physicians say misuse of antipsychotics is common.

Source: Kaiser Daily Health Policy Report

Data on State Mental Health Agency Expenditures
Updated data on State Mental Health Agency (SMHA) expenditures from the National Association of State Mental Health Program Directors Research Institute, Inc. (NRI) are now available by state for Fiscal Year (FY) 2005. Per capita SMHA expenditures for FY 2005 are also available.

Study Finds that Number of Underinsured in the U.S. Increasing
This article, published in Health Affairs, estimates that there are nearly 25 million underinsured adults, a 60 percent increase from 2003. The rate of increase was steepest among those with incomes above 200 percent of poverty ($10,400 for an individual in 2008), where underinsurance rates nearly tripled. In total, 42 percent of U.S. adults were underinsured or uninsured.

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OTHER EVENTS

Enforcing Underage Drinking Laws Program Conference, August 21-23
The 10th Annual Enforcing Underage Drinking Laws Program Conference, "A Notable History: Forging the Future," will be held August 21–23. Conference workshops will address a variety of topics, including educational sessions on the health impacts of different types of alcohol and mixed drinks, coalition building, policy implementation and policy enforcement, promoting youth advocacy, case studies and best practices at the local and State levels, student involvement in reducing underage drinking, and other strategies. Roughly 2,000 participants are expected this year.

NASMHPD Forensic Division Annual Meeting, September 21-24
The National Association of State Mental Health Program Directors Forensic Division is hosting its 2008 Annual Meeting in Pittsburg, Pennsylvania from September 21-24. Topics to be discussed include jail diversion and behavioral health services. Registration for this event is now open.

Trauma-Informed Care Webinar, June 24, 2-3 PM EST
Witness Justice is hosting a virtual training, "Trauma 101- Trauma and Trauma Informed Care". This introductory session will provide a basic understanding of the nature and impact of trauma and trauma-informed care and is geared for service providers of all types.  The session aims to help service providers recognize trauma and provide an understanding of how and why trauma is a common experience for survivors of violence, abuse, neglect, disaster, terrorism, and war. Further, it will help service providers develop a trauma informed approach to working with survivors. This webinar will feature Helga West, President & CEO of Witness Justice. This one-hour training course is $75 per participant.

Conference Call on the 2008 Physician Quality Reporting Initiative for Family Physicians, July 1, 2-3:30 PM EST
The Centers for Medicare & Medicaid Services (CMS), along with the American Academy of Family Physicians (AAFP) will host a special open door forum to discuss participation in the 2008 Physician Quality Reporting Initiative (PQRI). This call will take place on July 1, 2008 from 2:00 pm – 3:30 pm, ET. The purpose of this forum is to provide information that will encourage PQRI participation. The focus will be on the simple steps that Family physicians can use to collect and report quality data to be eligible for an incentive payment from CMS. Family physicians are encouraged to join. Participation is free, but capacity is limited, so please dial in early if interested. Call in: 1-800-837-1935, reference Conference ID: 53531104.

Webinar on Recovery-Oriented Services for Individuals who are Homeless, July 8, 12-1 PM EST
The Homelessness Resource Center is sponsoring an upcoming webinar, “Achieving Recovery-Oriented Services for People Suffering Homelessness”. Cheryl Gagne of BU’s Center for Psychiatric Rehabilitation, will explore the notion of recovery-oriented services for people experiencing homelessness. We will present an overview of a recovery-oriented framework; identify benefits and challenges; and discuss promising strategies for implementation. Registration is free.