September 9, 2011

Media Explores State Mental Health Policy Issues

Over the last month, media outlets across the country have highlighted a variety of issues and developments surrounding the treatment of individuals requiring mental health care.

The Chicago Tribune reported on a new “prior authorization” policy, which took effect in May, for mental health patients on Medicaid. That requires doctors to get prior authorization before prescribing one of 17 brand-name psychiatric drugs instead of a lower-cost generic formulation.  The measure is an effort to trim $90 million from Illinois’ $14 billion Medicaid budget.  The article cites the case of the brand-name psychiatric drug Lexapro, which costs $110 per prescription, while the generic version only costs $7.  However, mental health caregivers have claimed that difficulties in the prior authorization process have forced some patients off of the drugs, leading to a deterioraration in condition, sometimes requiring hospitalization.  Additionally, while some patients have been able to transition to the generic  versions without difficulty, some providers are reporting that the generic versions of some drugs have created serious side effects in other patients that were not evident in the brand-name versions.

The Minneapolis Star Tribune highlighted the upcoming fall implementation of a new psychiatric hotline that primary care physicians must call before prescribing large doses of antipsychotics or other drugs to children on state-funded health plans, amid questions of whether primary care physicians may be misdiagnosing mental health conditions and prescribing drugs that may be ineffective or harmful.  According to the article, Minnesota has 33% fewer psychiatrists per capita than the national average, and primary care physicians prescribe 80% of the psychiatric drugs administered in the state.

The New Orleans Times-Picayune noted that Louisiana was in the process of contracting with a publicly-traded managed care specialist “to run an overhaul and expansion of mental health and addiction services for the state’s Medicaid and uninsured populations.”  While the contract must be negotiated and approved by federal authorities, the article reports that it is a piece of Governor Bobby Jindal’s plan to shift “much of the Medicaid insurance system from the existing fee-for-service model to a system of coordinated-care networks.”  The plan aims to convert state general fund money into matching federal Medicaid dollars in the hopes that it will create more providers of mental health and addiction care to the uninsured population of the state.

The editorial board of the Concord Register recently criticized the state of mental health care in New Hampshire, framing it as a public safety issue and urging increased attention before further budget cuts are made.  The editorial highlighted the closure of a psychiatric unit at one hospital, due to low Medicaid reimbursement rates, as increasing pressure on the state psychiatric hospital, which only has 157 beds to serve the entire state.  The piece claimed that the state’s mental health care system was in “triage mode” and cited a Department of Justice report that the state was violating the Americans with Disabilities Act for a failure to provide adequate mental health care in community settings.

In addition, we recently highlighted emergency rule making by the New York State Office of Mental Health which implemented a 1.1% Medicaid fee reduction for operating rates of continuing day treatment programs.

This post was contributed by David Nardolillo.