CMS Responds to Our Concerns-Rescinds Proposal to Limit Access to Psychotropic Medications

Responding to a huge outpouring of concerns and complaints from the mental health advocacy community across the country and also to pressure from Congress, the Center for Medicare and Medicaid Services (CMS) reversed its decision to limit access to psychotropic medications.  Virtually every mental health organization in Illinois and across the country communicated to CMS  and to Congress our opposition to this proposal which would have allowed Medicare Part D providers to restrict access to medications for the treatment of serious mental illnesses.  Bravo to everyone who joined in the effort to stop this bad policy from taking effect.

In the meantime, Congress is considering legislation to prohibit CMS from going forward with such a rule.  

Below are links to information about the  CMS change of heart:

Partnership applauds CMS

Obama drops Medicare Proposal

National Council press release

NAMI press release

New York Times article–March 11, 2014



The Centers for Medicare and Medicaid Services (CMS) wants to significantly limit access to antidepressant and immunosupressant medication for people subscribing to Medicare Part D. Read today’s post to learn why you should be concerned, and what you can do to support the mental health community by raising our voices in Washington.

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that would remove antidepressants and immunosupressants from the protected class status under Medicare Part D and is considering removing antipsychotics from the same status the following year. If CMS adopts its proposal, it would reduce patient access to and the availability of mental health treatment.

Since it went into effect in 2006, Medicare Part D’s protected class structure ensures patients with mental health conditions have access to all or substantially all of the most appropriate medications, protecting them from “fail-first”1 experiences or other appeals processes. In many cases, delays caused by these processes can result in inadequate treatment and potentially tragic outcomes.

We need to ensure that all mental health patients have access to all the medications that they need. It is clear that CMS’ rule will signal a step in the wrong direction and the consequences will be detrimental. According to the World Health Organization, depression is currently the leading cause of disability worldwide. By 2030, it will be the leading global burden of disease.2 In the United States alone, the total direct and indirect cost associated with depression exceeds $83 billion annually.3

Ultimately if CMS’ rule is approved, there will be severe human, economic and societal consequences for not only mental health patients, but for all Americans. We must take action now.

Here’s How You Can Take Action Today

Now, more than ever, the mental health community of patients, families, friends and others need to join together to tell CMS and the Administration how big of a mistake implementing this rule will be for all Americans. Below you’ll find several ways in which you can make your voice heard during CMS’ open comment period, ending March 7, to protect antidepressants, immunosupressants and antipsychotics within Medicare Part D. The clock is ticking!

  1. Make Your Voice Heard by writing to your Member of Congress. Use the sample email letter to inform your member of Congress that the implementation of this proposed rule is a big mistake. Be sure to share any personal experiences and how this rule will impact you or a loved one.
  2. Share your personal stories: The Care For Your Mind blog is interested in your personal stories to help share the extent of the issue and how it will impact you or a loved one. While this rule is expected to decrease patient costs for medications, members of the mental health community understand the treatment for our conditions is far from one size fits all. Below are a few questions that may help you shape and share your story:

a. What will happen if you lose access to your medications?
b. Have you had a negative experience with “fail-first” experiences?
c. How will the new rule impact you, your parents, other family members or friends?

We encourage you to submit your personal story here for publication on our website. And in the meantime, join our conversation online by contributing to this blog below. Your voice counts and the time to speak up is now!

Share this information with others: Knowledge is power. The more people know about the proposed rule’s real life consequences, the more we can make our voices heard. Share this post and relevant information with your friends and family, on your social media accounts, through email and word of mouth offline.Together, we can send a powerful message and help ensure that patients have access to the medications they need and deserve.

Here is an action link.

Here is a recent article on this topic

Fixing Illinois’ Fiscal Crisis a Top Priority for Mental Health Advocates

Several years ago, faced with a fiscal crisis, Illinois enacted a “temporary” income tax increase.  That income tax increase will expire (“sunset”) on December 31, 2014 unless the Illinois legislature passes and the Governor signs, legislation to extend it.  If the tax increase is not extended (or some other substantial source of revenue identified) Illinois will be facing a $4 to $5 billion hole in its budget.  While there is certainly some waste in the state’s budget, it is not possible to identify $4-5 billion in cuts which will not result in dramatic reductions in mental health services and all other human services as well as in state funding for schools and other vital government programs.

2014 is an election year for the Governor, most of the Illinois Senate seats and all of the seats in the Illinois House.  Mental health advocates are urged to communicate to all legislators and all legislative candidates in the upcoming primary our support for legislation extending the current state income tax rates.   

One of the problems with the Illinois income tax is that the Illinois Constitution prohibits progressive taxation of any kind.  Thus, millionaires pay the same income tax rate as those making very minimal amounts.  This makes it difficult to raise revenue or even maintain our current tax rates without harming some of our most vulnerable citizens.  The Mental Health Summit supports efforts to place on the Fall Election Ballot an amendment to the Illinois Constitution which would permit the legislature to enact a progressive tax system.  Mental health advocates are urged to communicate to all candidates their support for placing this amendment on the Fall ballot so that all voters can consider this important issue.  Resolutions which would accomplish are pending in both the Senate and the House.  Please urge all Senate candidates to support Senate Joint Resolution  Constitutional Amendment 40 (Harmon).  Please urge all House candidates to support House Joint Resolution Constitutional Amendment 33 (Jakobsson).

Click here for information about the budget crisis.

Click here for a recent article about the crisis.

Increasing Access to Psychotropic Medications

The Mental Health Summit is working with other groups to remove obstacles preventing persons with serious mental illnesses from obtaining the medications they need to treat their illnesses.  Last year the Illinois legislature passed a law limiting Medicaid recipients to four prescription medications each month.  Any person needing more than four medications must obtain permission (“prior authorization”) from the Illinois Department of Healthcare and Family Services.  Unfortunately that process is excessively burdensome and many patients simply give up.  There is substantial evidence that this type of restriction harms persons with mental illnesses and actually costs Illinois taxpayers more money paying for the costs of increased hospitalizations and other negative outcomes.  Fortunately, there are several bills pending in the legislature which are designed to fix all or part of this serious problem.  The Summit urges mental health advocates and others to support the following bills.  Specifically, please ask your state senator and state representative to sign on as co-sponsors of these bills:

House Bill 2469 (Chapa Lavia) removes some psychotropic medications from the 4-drug restriction

House Bill 3671 (Flowers) would eliminate the 4-drug restriction entirely

House Bill 3688 (Harris) removes some generic psychotropic medications from the 4-drug restriction.

Senate Bill 2611 (Hastings) removes some psychotropic medications from the 4-drug restriction

The Summit is also working with other health care groups to make the prior authorization process more user friendly for physicians.  Two bills have been introduced with the goal of having a uniform and easy to use prior authorization process which would work no matter which insurance company or other third-party payer was involved.  The precise language of these bills is still being worked on.  The Summit urges advocates to watch this space for an update when these bills are ready for consideration by the legislature.  The bills in question are:

House Bill 3638 (Representative Fine)

Senate Bill 2585 (Senator Kotowski)

Medicaid Expansion Approved–Governor Issues Signing Statement Critical of IMD Expansion

On July 22, 2013, Governor Quinn signed Senate Bill 26 into law as Public Act 98-0104.  Mental health advocates are thrilled that this law will implement the Affordable Care Act in Illinois by expanding Medicaid to 138% of the poverty level.  This expansion will result in the largest increase in mental health funding in the state since the enactment of Medicaid decades ago.

Unfortunately, the Governor did not heed our call to issue an amendatory veto of SB26.  The Summit and other advocates sought this veto to remove the last minute addition of provisions greatly expanding the services to be provided by the 24 so-called “IMD” nursing homes. The Summit, however, was hearten by thesigning statement which accompanies the Governor’s approval of this bill.  The Governor expressed his concerns about the addition of the new law governing nursing homes for people with mental illnesses (now to be called Specialized Mental Health Rehabilitation Facilities) and promised to take steps to insure that the new law does not undermine Illinois’ commitment to re-balance the mental health system in Illinois away from an excessive reliance on out-dated institutions.  The Summit stands ready to work with the Quinn Administration to implement this commitment.

Medicaid Expansion Yes; IMD Expansion No. Call Governor Quinn Now!

Urgent Action Required: Ask the Governor for an Amendatory Veto of Senate Bill 26

Please note that as of July 16, 2013, the Governor has yet to act on this bill.  So there is still time to call him and ask for an amendatory veto!!!

The Mental Health Summit strongly supports the expansion of Medicaid.  Senate Bill 26 enables Illinois to fully implement Medicaid expansion under the Affordable Care Act, paving the way for hundreds of thousands of individuals who are currently uninsured to receive Medicaid benefits for the first time and for the State to receive an unprecedented infusion of federal dollars to pay for those benefits.

However, the Mental Health Summit opposes House Committee Amendment Number 1 to SB 26, which expands the scope of services provided by Specialized Mental Health Rehabilitation Facilities.  Specifically, we urge an amendatory veto of SB 26, deleting pages 1-40.  These provisions deliver yet another blow to the mental health community by diverting necessary funding away from community mental health services towards Institutions for Mental Diseases (IMDs).  Contrary to the needs of mental health patients, these IMDs are concentrated in a limited geographic area, forcing patients to travel long distances to receive inadequate treatment.  Further, this diversion of funds will continue the excessive institutionalization of persons with mental illnesses in IMDs.

We urge you to call and/or write Governor Quinn to have him issue an amendatory veto of SB 26 that removes only the Specialized Mental Health Rehabilitation Provisions of the bill included on pages 1-40:


Governor Pat Quinn

James R. Thompson Center

100 W. Randolph, 16-100

Chicago, IL 60601

Phone: 312-814-2121

Fax: 312-814-5512

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.