Medicaid Expansion Yes; IMD Expansion No

On May 21st. Senate Bill 26, which will provide substantial new funding for mental health services in Illinois by expanding Medicaid coverage, was amended by House Committee Amendment Number 1.  This amendment will divert money from the community mental health system to a small number of IMD nursing home owners so that they can continue the excessive institutionalization of persons with mental illnesses.   A new category of facility called Specialized Mental Health Rehabilitation Facilities (SMHRFs) is being dramatically expanded.    New funding for much-needed community services will only be available in inappropriate institutions instead of in community settings.

It is urgent that we all call the sponsors of this legislation and tell them that the SMHRF amendment must be removed from Senate Bill 26.   The sponsors are Representative Sara Feigenholtz and Senator Heather Steans.  Also call your own state representative and urge her/him to communicate this message to Representative Feigenholtz.

Click here for a link to your state representative.

Good News: Senate Bill 26–Medicaid Expansion–Posted For Hearing in House Human Services Committeee

Update:  May 20, 2013–Senate Bill 26, which expands Medicaid coverage to many more persons with serious mental illnesses, has been posted for a hearing in the House Human Services  Committee for 9am on Tuesday, May 21, 2013 in Room C-1 in the Stratton Building.   Please contact members of that committee and voice your support.  You can also fill out a witness slip supporting the bill.  

January 17, 2013–President Obama has recognized that Medicaid expansion is vital to fixing our broken mental health system and made this an urgent priority in his recommendations on gun violence issued yesterday.  This is yet another reason to implement the Affordable Care Act in Illinois.

The Affordable Care Act is the most important piece of legislation effecting persons with mental illnesses since the enactment of Medicaid.  Serious mental illnesses, while highly treatable, are often incurable, They are most commonly diagnosed during adolescence of early adulthood.  Thus, they constitute “pre-existing conditions” which are used by health insurance companies to deny coverage.  The Affordable Care Act helps people with serious mental illnesses because: (1) it prohibits insurance companies from denying coverage based upon a pre-existing conditon; (2) it provides substantial financial incentives to states to expand Medicaid coverage to many people with serious mental illnesses; and (3) creates less expensive insurance for persons who are not eligible for Medicaid.  Persons with serious mental illnesses and all Illinois taxpayers will greatly benefit from full implementation of the ACA in Illinois.   Each state can decide whether it will implement the Affordable Care Act.  The passage of House Bill 106 or Senate Bill 26, which were  just introduced, will insure full implementation of the ACA.  The Summit urges all who care about mental health services to communicate to their state senator and state representative their support for passage of  these identical bills– full implementation of the ACA.

Click here for more information about this legislation.

Click here to locate your state legislators.

Summit Urges Passage of House Bill 2469–Carve out psychotropic medications from 4-drug limit

Representative Chapa LaVia has introduced House Bill 2469 to carve out  many psychotropic medications from the draconian 4-drug limit on Medicaid recipients imposed by last year’s SMART Act.  The SMART Act includes a provision requiring Medicaid recipients to get prior authorization from their doctor for any prescription medications over four per month.  This means each month Medicaid recipients who receive over four medications would be required to have each doctor for those additional prescriptions send paperwork to the Department of Healthcare and Family Services justifying those additional prescriptions.  Each month the prescription and doctor could be different depending on the order the prescriptions are sent to the pharmacy.  This creates a burden on the patient, as well as burdens on the doctor and the Department of Healthcare and Family Services.  Unfortunately many persons with mental illnesses and their doctors, when  faced with the burdensome prior authorization process, simply give up and then the person’s mental health condition deteriorates.  Over 200,000 Medicaid recipients take over four prescription medications.

The costs of this provision will outweigh any savings the legislature was hoping to gain.  The Summit is suggesting a number of possible changes to ease the burden o the Act in its current form.

• Eliminate the four-drug limit entirely.
• Amend the SMART Act to exempt from the four-drug limit persons who are on Medicaid due to a disability.
• Amend the SMART Act to exempt psychotropic medications, or at least, exempt anti-psychotic and anti-depressant medications.
• Improve the prior authorization process:
  • Create an electronic (email or web-based) submission process.
  • Increase transparency by publishing standards and procedures for prior authorization.

If you would like to help please contact the state legislators involved in the enactment of this Act (contact information for each provided in the links below): Senator Heather Steans (D), Senator Dale Righter (R), Representative Patti Bellock (R), and Representative Sara Feigenholtz (D).

For more information please see the links below.

Letter to personalize and send to your state legislators

Click key legislators names for contact information:

Senator Heather Steans (D)                       Senator Dale Righter (R)

Representative Patti Bellock (R)              Representative Sara Feigenholtz (D)

The SMART Act in its entirety; the 4 drug limit is in provision 305 ILCS 5/5-5.12 Pharmacy Payments

Summary of Driscoll and Fleeter research

Driscoll & Fleeter for NAMI Ohio research discussing the rise of costs under a prior authorization program

Exclusion of Antipsychotics from Four Drug Limit_Fact Sheet

CBHA report on the effect of the 4-drug limit so far (October, 2012)

The Illinois Department of Healthcare and Family Services Annual Report for FY11; this report was used by Thresholds in addition to the Driscoll & Fleeter research to apply it to Illinois

Report showing magnitude of co-occuring mental and physical illnesses

Urgent Action Item–Reinvest savings from closing Tinley Park and Singer MHCs

We need YOUR help to protect mental health needs in Illinois! Tinley Park Mental Health Center closed in July and Singer Mental Health Center will close on October 31. The Governor’s administration plans to strip the mental health community of over $9 million in savings from the closures, despite requirements of law that these savings be reinvested in alternative mental health services. This is unacceptable. It will harm our fellow Illinois residents who are in desperate need for continued mental health services and in turn harm our communities. YOU can protect our friends and community members who depend on these services. Urge your state legislators to tell Governor Quinn that he cannot drain $9 million from mental health services.

Make a difference by taking three easy steps:

1.   Find the addresses for your state legislators here.

2.   Download the attached letter template and fill in your information.

3.   Mail your letters.

It’s that easy to make a difference! Learn more about this issue by viewing our memorandum.

Letter Template – Protect Mental Health in Illinois

Summit Concerns About the Closure of Tinley Park and Singer Mental Health Centers and the Failure to Reinvest Funds Appropriated for those Facilities

The Mental Health Summit is concerned because the Department of Human Services (DHS) has announced that it does not intend to use the money appropriated in Public Act 97-0730 (Senate Bill 2454) either to keep the nine state-operated facilities open or for transitional services in the community. We believe that the Department’s plans:

1.   violate the legislative intent of specific appropriations set forth in Public Act 97-0730;

2.   violate the Funding Reinvestment Statutes; and,

3.   will cause serious harm to persons with serious mental illnesses, particularly persons in

the area which has been served by Tinley Park Mental Health Center.

Public Act 97-0730 (the relevant excerpts are attached as Exhibit A) contains two specific provisions to fund the nine state psychiatric hospitals:

Section 55 provides:

The sum of $202,659,400, or so much as may be necessary, is appropriated from the General Revenue Fund to the Department of Human Services for costs associated with the operation of Alton, Chester, Chicago Read, Choate, Elgin, Madden, McFarland, Singer and Tinley Park State Operated Mental Health Facilities or the costs associated with services for the transition of State Operated Mental Health Facilities residents to alternative community settings. (Exhibit A, p. 51)

Additionally, Section 65 includes the following appropriation:

For costs associated with Mental Health Community Transitions or State Operated Facilities…………..$24,867,000

(Exhibit A, p. 53)

In response to a suit filed by Mental Health America of Illinois and the National Alliance on Mental Illness-Illinois, DHS advised the court in writing that it cannot keep Tinley Park open beyond July 2, 2012 or reinvest the funds in community services because only the first of these appropriations ($202 million) is available for these two alternate purposes. (See excerpts from the DHS brief attached as Exhibit B, p.14.) The Department does not intend to spend the second appropriation of nearly $24.8 million on either state facilities or transitions.

DHS has also announced that, even though there will be $18 million in savings from the closure of Tinley Park, it will only reinvest $12.8 million of these funds. The remaining $5.2 million will be spent on another legal obligation currently imposed upon DHS–compliance with the Williams v. Quinn consent decree. (Exhibit B, p. 14) This expenditure violates the language and intent of the Funding Reinvestment Statute. (The Funding Reinvestment Statute is attached as Exhibit C) If DHS can count funds which it would be required to spend even without a facility closure as a “reinvestment” then the Reinvestment statute means absolutely nothing. The Funding Reinvestment Statute was designed to fund specific additional community services that become necessary whenever a hospital is closed.

Counting funds needed to satisfy the Williams v. Quinn consent decree as reinvestment for the closer of Tinley and Singer is particularly outrageous since DHS is under a Federal court order to spend this money on persons leaving Iinstitutes for Mental Diseases (IMD) nursing homes, not on persons in the Southland region who will no longer be able to get services from Tinley Park. Most of the IMDs are located on the North Side of Chicago, not in Will, Grundy, Kankakee and South Cook Counties–the area served by Tinley Park.

Moreover, Public Act 97-0730 has a separate appropriation of $16.7 million to comply with the Williams, Colbert and Ligas nursing home consent decrees (Exhibit A, Section 60, p. 52). If this appropriation is insufficient to satisfy the legal requirements imposed on Illinois by these decrees, the Federal judges may use their contempt powers to encourage the Governor to obtain a supplemental appropriation. The Governor should not violate the legislative intent of Public Act 97-0739 and the legal requirements imposed Funding Reinvestment Statute.

The DHS position about “reinvestment” raises additional concerns about adequate community care because of the DHS plan to close Singer on October 31, 2012. The FY2012 budget for Singer was $14 million. Like Tinley Park, the State has announced that it will only spend a portion of these funds as reinvestment. That is, although only $5 million will be spent at Singer during the four remaining months of its operation (July 1 through October 31), of the $9 million in savings only $4.8 will be reinvested. The other $4.2 will spent on unrelated purposes. Yet again DHS has decided it need not spend the money appropriated by the legislature and it need not comply with the Funding Reinvestment Statute. The fiscal justification for this decision is even more hard to fathom since DHS has admitted that it does have the funds to keep open (or reinvest in community services) eight of the nine hospitals. (Exhibit B, p. 14) Since it has now closed Tinley Park, Singer is one of the remaining eight facilities for which it admits it has funds.

Finally, the Mental Health Summit’s main concern is not that DHS is violating the law, but that DHS’ plans will seriously harm persons with mental illnesses. The $12.8 million which the state has chosen to reinvest in services in the Tinley Park region and the $4.8 million in the Singer region will simply not be sufficient to insure a safe transition to community care. Because DHS refuses to spend the money appropriated by the Illinois Legislature and required by the Funding Reinvestment Statute, persons with mental illnesses in Illinois and their families and communities will be seriously harmed.

Summit testifies at hearing on closure of Singer Mental Health Center–August 7, 2012

Rachel Betts presented the Summit’s written and oral testimony concerning the proposed closure of Singer Mental Health Center at a hearing in Rockford on August 7, 2012.  The Summit does not oppose the closure but opposes the Department of Human Services plan for that closure because; (1) the Department is refusing to reinvest the money saved from the closure in alternative service in violation of Illinois law; (2) the Department’s plan relies on replacing the 76 beds at Singer with services at Elgin, McFarland and Read, even thought it has no plan to increase capacity at these already overcrowded facilities; and (3) the Department has claimed that it lacks the funds to keep the facility open or reinvest the savings from the closure despite the fact that funds were expressly appropriated for these purposes.

Click here for news coverage of the hearing.

Written testimony presented by Summit at Singer closure hearing on August 7, 2012

Budget update–July 3, 2012

The Governor has now signed into law the Human Services budget passed by the Illinois Legislature on May 31, 2102.    This budget, contained in Public Act 97-0730, gives the Governor discretion to close any of the nine state mental hospitals but appropriates a total (in two line items) funding for state hospitals and transitions which exceeds the current amount being spent on state facilities.  Specifically, for the current fiscal year (FY2012), the appropriation for state hospitals was $224.5 million.  Senate Bill 2454 contains only $202.7 million for state facilities (Section 55, page 52, lines 1-9) but also appropriates $24.9 millioin for “mental health community transitions or state operated facilities” (Section 65, page 54, lines 2-4) for FY2013.  Unfortunately, the Department of Human Services has announced that it  does not intend to reinvest the money saved from the closure of Tinley Park on July 2nd and the the closure of Singer on October 31st .

The budget bill also appropriates  $16.8 million for “rebalancing and transition costs associated with compliance with consent decrees.” (Section 60, page 52, lines 10-18).  Presumably this is money to comply with the Williams v. Quinn and Colbert v. Quinn decrees.

The budget cuts $30 million (20%) from General Revenue Funding for community services grants, reducing this line from $144 million to $114 million.   There are 2 new pots of money to support community services each with $20 million in them.  However, there is some concern about whether these funds will really be available and, if so, when.

Funding for psychotropic medications in the community was cut from $1,980,000 to $1,900,800 (4%)

The entire line item of $742,000 for mental health transportation (getting people to state hospitals from remote counties) was eliminated.

Teen suicide prevention funding ($206,400) was eliminated.

Supportive housing funding was increased from $3.3 million to $5 million

Further analysis of the budget will be provided soon.

CBHA analysis of FY2013 budget passed by the legislature on May 31, 2012