Monday, October 11, 2004

Medicare Demonstration PPOs
A September GAO report to the House Finance Committeein Adobe Acrobat format - "Preferred provider organizations (PPO) are more prevalent than other types of health plans in the private market, but, in 2003, only six PPOs contracted to serve Medicare beneficiaries in Medicare+Choice (M+C), Medicare’s private health plan option. In recent years, the Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare, initiated two demonstrations that include a total of 34 PPOs. GAO (1) described how CMS used its statutory authority to conduct the two demonstrations, (2) assessed the extent to which demonstration PPOs expanded access to Medicare health plans and attracted enrollees in 2003, (3) compared CMS’s estimates of out-of-pocket costs beneficiaries incurred in demonstration PPOs with those of other types of coverage, including fee-for-service (FFS) Medicare, M+C plans, and Medigap policies in 2003, and (4) determined the effects of demonstration PPOs on Medicare spending."  
  

Safe and Effective Approaches to Lowering State Prescription Drug Costs: Best Practices Among State Medicaid Drug Programs
A September CMS/HHS report in Adobe Acrobat format - "As a result of increasing prescription drug costs, State Medicaid programs have implemented a variety of cost-containment mechanisms in their drug programs over the past few years. These mechanisms have allowed states to reduce their pharmacy expenditures and maintain beneficiary access to a vital part of their overall healthcare. This paper describes some of these cost-containment mechanisms and highlights several states that have achieved reduced costs with each technique. In general, states have not yet taken advantage of all of these approaches. CMS can provide consultation and support to assist states in using these and other methods to lower their drug costs without compromising quality of care."  
  

Preferred lists for drugs such as Prozac? (Virginia)
October 7 Richmond Times-Dispatch story - "State Medicaid officials yesterday moved closer to making antidepressants such as Prozac and Zoloft subject to tighter prescribing procedures - but just how strict is yet to be determined. In an effort to control costs, the state agency has created lists of preferred drugs that doctors select from when prescribing drugs for Medicaid patients. That way, the state can negotiate better prices on the preferred drugs. At the urging of mental-health advocates, antidepressants and anti-anxiety drugs had been excluded from that process - until yesterday. Despite testimony from advocates that psychotropic drugs should be given special consideration, the Medicaid agency's Pharmacy and Therapeutics Committee yesterday voted to consider preferred drug lists in those categories..."  
  

States Find Creative Uses For Treatment Grants
Psychiatric News story - "People seeking help for drug and alcohol abuse and dependence in a number of states will benefit from a federal treatment initiative that provides vouchers to pay for individualized care. Fourteen states and one tribal community are the recipients of a total of $100 million in Access to Recovery grants for people seeking treatment for drug and alcohol problems. Access to Recovery is a three-year federal treatment initiative proposed by President George W. Bush in his 2003 State of the Union address. The program is administered by the Substance Abuse and Mental Health Services Administration and is designed to help people with substance abuse and dependence to find treatment in their communities." See also the overview of the Access to Recovery faith-based initiative (Adobe Acrobat format).  
  

Mental health dispute lands back in court today (Arizona)
October 8 Arizona Republic story - "State health officials and mental-health attorneys are divided over the best way to provide better care to the Valley's seriously mentally ill on the heels of a critical performance audit of the system. The parties are being called into court today to hammer out a joint plan for improvements following the August audit that found that despite getting $230 million in extra funding, the system had reversed course and was worse off in some areas than it was four years ago." See also the follow up story the next day, Judge orders fast action on mental-health system - "Repeatedly chastising the state for poor monitoring, a Maricopa County Superior Court judge on Friday ordered it to come up with a plan to fix the Valley's mental-health system by mid-December. Judge Pro Tem Bernard Dougherty told the state to return in two months with a detailed report on how it will comply with court orders under the Arnold vs. Sarn case, which is more than two decades old."  
  

Backers say mental health levy to keep programs alive (Ohio)
Toledo Blade story - "The Lucas County Mental Health Board helps fund mental health care for thousands of county residents, but now the board says it needs some help of its own. 'We're just trying to stay above water,' Jackie Martin, the board's executive director, said of her organization's struggle to keep up with increasing demand. Four years ago, the board funded services for 11,729 clients. But a poor economy and a growing number of residents without health insurance have sparked a 27 percent increase in those getting help, with 14,881 people getting some aid from the board. That aid includes help with medication expenses and providing housing, counseling, and emergency services. The board seeks a 10-year, 0.5-mill replacement levy on the Nov. 2 ballot, bringing in $4.4 million annually, a net increase of $1.9 million over the existing levy."  
  

Mental health advocates hope for respite in Prop. 63 (California)
Times-Standard story - "Humboldt County Mental Health Director Lance Morton said he's worked in various counties' mental health programs for 27 years, and has seen his budget shrink for 20 of those years. Morton and local families of mentally ill people are hoping that Proposition 63 will turn a bit of that around. The proposition would impose an additional income tax of 1 percent on taxable income above $1 million beginning Jan. 1 and put the money into a fund for counties' mental health services..."  
  

Mental health care: need and value
Roanoke Times editorial - "Sometimes, the evidence in support of improved access to mental health care is like mental illness itself: starkly real, devastating in effect and largely unseen or disregarded by the unaffected majority. The evidence mounts all the same. With it grows the need for funding from state and federal governments, health insurers, charitable foundations and private citizens. Though mental illness can afflict anyone, the most compelling recent warning addressed a specific group. According to the secretary of veterans affairs, the brutal guerrilla war in Iraq will cause many U.S. troops long-term mental health problems..."