May 21, 2007 - Vol 1, Issue 15
Advocacy Alert: Coordinated Care Listening Forums
Report on New Paltz Listening Forum
As you know four state commissioners Richard Daines from DOH, Karen Carpenter-Palumbo from OASAS, Diana Jones Ritter from OMRDD, and Michael Hogan from OMH - are hosting a series of listening tours around the state to obtain input from people who use multiple service systems as well as from the providers that work with them regarding their experience with access, quality, and coordinated care.
Michael Friedman and other members of the Alliance attended the first listening forum in New Paltz on May 14th. There was an enormous turnout - around 500 people. Upon arrival attendees were asked to fill out comment cards, which were then collected and organized by issue area. After brief statements from each of the four Commissioners, attendees were randomly selected to make their comments. Only about 20 people had the opportunity to speak, and none of the members of the Alliance were called on. Sadly no one spoke about aging, let alone about the mental health needs of elders!
IN ORDER TO MAKE GERIATRIC MENTAL HEALTH A FRONT BURNER ISSUE AT THESE FORUMS YOUR ATTENDANCE AND VOICE IS NEEDED.
Here is when the additional forums will be held:
NYC - June 6th from 12:00-2:00pm
Location: York College / CUNY, 94 - 20 GUY R. Brewer Blvd., Jamaica, NY 11451, 718-262-2000
Buffalo - June 19th from 4:00-6:00 PM
Location: Roswell Park Cancer Institute, David C. Hohn, MD, Lecture Hall, Research Studies Center, Corner of Elm & Carlton Streets, Buffalo, NY 14263, 877-275-7724 or 716-845-2300
Syracuse - June 20th from 2:00 to 4:00 PM
Location: Renaissance Hotel, Lafayette Theater, 701 East Genesee Street, Syracuse, NY 13210, June 20, 2007, (Registration begins at 1:30 PM), 1-315-479- 7000
Plattsburgh - 7/13/07 (details to be announced)
PLEASE LET US KNOW IF YOU OR ANY OF YOUR CONSTITUENTS WILL BE ATTENDING.
As a reminder you should arrive early as seating is limited and will be on a first come, first serve basis. The comment cards you will be asked to fill out are available online for you to complete in advance.
For your convenience, here is a list of possible talking points on geriatric mental health. The talking points are much too long to fit on a card however, we tried to outline major concerns that individuals could then choose from to mention.
If you cannot attend any of the forums but want to provide feedback, you can submit comments online. If you do submit comments, please send them to us.
For more information about the listening tours, please visit the OMH website.
We really hope that you will be able to participate.
PLEASE LET US KNOW IF YOU OR ANY OF YOUR CONSTITUENTS WILL BE ATTENDING.
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NYSOMH Releases Update to 5.07 Plan
OMH recently released the 2007 Update and Interim Report to the 2006- 2010 Five Year Plan for Mental Health Services.
The report notes OMH's Geriatric Mental Illness Initiatives including the Interagency Planning Council and the geriatric mental health demonstration projects. The report also mentions enhancing access to effective community-based services for older adults as a priority for OMH that we will carried out by annualizing the Geriatric Mental Health Act at $2 million. The public testimony submitted from April-May 2006 is also summarized in the report and highlights the numerous recommendations made regarding improving geriatric mental health practice and policy including recommendations related to promoting programs that support older adults to remain in the community, family support, new financing structures, integration of services, public education, cultural competence, workforce development and much more.
OMH will be scheduling hearings on the plan. We will notify you once they have been scheduled.
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Advocacy Alert: Medicare Mental Health Legislation
Adapted from Bazelon Center Mental Health Policy Reporter
The chairman of the House Ways and Means Subcommittee on Health, Rep. Pete Stark (D-CA), has re-introduced H.R. 1663, the Medicare Mental Health Modernization Act of 2007, to update Medicare's mental health benefits. The legislation would provide coverage of community-based services, including psychiatric rehabilitation and intensive case management. Additionally, the bill would eliminate the discriminatory outpatient co-payment of 50% for mental health services, compared to 20% for other outpatient services.
Please send a letter to Representative Sparks in support of the legislation. Click here for a sample letter that you can cut and paste on your own letterhead.
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GMHA Conference
Geriatric Mental Health: Challenges and Opportunities Across the Horizon
Thursday, May 31, 2007
9:00am - 4:00pm
New York Hotel Pennsylvania
New York City, New York
Click here for the updated brochure and registration information.
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Upcoming Events
May 21, 2007 - Building Community: A Conference Addressing Geriatric Mental Health Awareness & Advocacy sponsored by JPAC and JASA from 9am-12noon at UJA Federation of New York, 130 East 59th Street, 7th Floor, NYC. Advanced registration is required.
Please see flyer for more information.
May 23, 2007- Introduction to Aging and Developmental Disabilities It is essential that clinicians, nurses, and direct support professionals are trained in basic biological aging, specific risk factors based on the factors of aging interacting with the preexisting disability, and an overview of the importance of quality geriatric assessment. Topics will include the biological process of aging; differences and similarities in the aging process among persons with DD and the general population; the components of geriatric assessment; the impact of medications; and differential diagnosis.Training Location: RRTI Training Center, 155 Washington Ave, Suite 410. Click here to download flyer.
May 24, 2007 - Preparing for the Elderboom: Strategies for Success through Workforce Development and Advocacy - an all day conference sponsored by the New York Southern Area Aging Network. There will be a workshop sponsored by the Geriatric Mental Health Alliance on workforce development to meet the mental health needs of older adults. The conference will take place from 8:30- 3:30pm at the Fordham University Law School, Lincoln Center Campus, 140 West 62 Street, NY, NY. Please click here for the brochure and registration information.
May 30, 2007 - Personal Empowerment: Becoming a Proactive Health Care Consumer A workshop series focusing on health, wellness and recovery sponsored by NYC Dept of Health & Mental Hygiene - Office of Consumer Affairs. This workshop will provide you with practical information to successfully incorporate physical wellness strategies into your personal recovery oriented goals. Presenters are Cathy Holladay, Associate Director, Sky Light Center, Fern Fleckman, Director of Mental Health, and William F. Ryan Community Health Center Sky Light Center Member - Christopher Heath. The workshop will take place from 3 - 5 PM at 125 Worth Street, 2nd floor, Auditorium
June 14, 2007 - JASA Volunteer Ventures Expo A free half-day conference and volunteer opportunities fair for adults 50+. The event is from 9:30-2:00pm at the UJA Federation of New York, 130 East 59th Street, 7th Floor, NYC. Advanced registration is required.
See flyer for more details.
June 19, 2007 - SAVE THE DATE - Breaking Down Barriers: Elder Abuse: Addressing Financial Exploitation Through Partnerships A multidisciplinary conference sponsored by JASA, Hebrew Home for the Aged at Riverdale, The City of New York's Department for the Aging, Human Resources Administration, Fordham University, and New School University. The conference is from 8:30- 1:30 at the New School University Institute for Retired Professionals. Please see save the date cards (Card Front) (Card Back) for more info.
June 22, 2007 - 7th Annual Orange County Mental Health & Wellness Conference OMH Commissioner Michael F. Hogan and Geriatric Mental Health Alliance Chairman Michael Friedman to Keynote. The conference will take place from 8:30am to 4:00pm at Anthony's Pier 9 in New Windsor. For more information, please visit here.
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Rockland County Geriatric Mental Health Alliance Formed
New group formed to improve services for people with mental illness
Pomona - The Rockland County Department of Mental Health and the Mental Health Association of Rockland County Thursday announced the creation of the Rockland County Geriatric Mental Health Alliance, which has been formed to advocate for enhanced services for people struggling to be well as they age.
Mary Ann Walsh-Tozer, LCSW, commissioner of the Rockland County Department of Mental Health, and Karen Oates, DSW, president of the Mental Health Association of Rockland County, announced the formation of the alliance, which will join efforts with the Unified Services, Geriatric Mental Health Workgroup, formed last year by the county's Department of Mental Health. Made up of representatives from government and not-for-profit agencies that work with older residents, the Unified Services group focuses on planning and developing services for the mental health requirements of Rockland's aging population.
Walsh-Tozer said the two organizations would work closely together to help improve existing services and create new programs for people of all ages with mental illness, forging a long-term partnership that will enhance the quality of life for those who struggle with mental illness and to integrate mental health into healthy aging.
"The need for public education about mental illness in people of all ages is growing, but it is most crucial for our older population," she said. "The 'Baby Boomer' generation will turn 65 in just eight years, and in the next 25 years the number of older Americans will double," Walsh-Tozer said. "Changes are needed, and they are needed now. Public policy that provides adequate and appropriate funding for these services is essential for older people to get the treatment they need so that they can live out their lives in improved health and quality of life."
Click here for the article.
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In the News
APA Tells Congress: End Medicare's Higher Copay for MH Treatment
Psychiatric News
May 4, 2007 Volume 42, Number 9, page 1
© 2007 American Psychiatric Association
By Rich Daly
Having better-positioned supporters improves the odds that Congress will pass a bill eradicating Medicare's discrimination against mental health care, but costs remain uncertain.
The first step Congress should take to improve senior citizens' access to mental health care is to lower the Medicare copayment for outpatient psychiatric care to the level patients pay for non- mental health office visits, according to a former APA president.
Steven Sharfstein, M.D., immediate past president of APA, testified before the House Ways and Means Subcommittee on Health in March that the 50 percent copayment required for visits to psychiatrists or other physicians for mental health care is discriminatory and a barrier to care for a chronically undertreated group. Visits for other types of care require only a 20 percent copayment from the patient.
"There is simply no excuse for maintaining a discriminatory barrier to mental health care for America's seniors and disabled people, particularly since these populations have a disproportionately high incidence of mental health concerns," Sharfstein said.
Among the statistics that indicate the need for increased access to mental health care among seniors is a 1999 surgeon general's report that found 1 in 5 seniors experiences mental disorders that are distinct from cognitive changes associated with aging. People over age 65 also have been found to have one of the highest suicide rates, accounting for 20 percent of suicide deaths in the United States, while representing only 13 percent of the population.
"I believe that it is of critical importance that we advance mental health parity within the Medicare system," Sharfstein said.
Sharfstein's testimony during a hearing on a variety of mental health parity issues came as several members of Congress introduced legislation that would eliminate the Medicare copayment disparity. Among the highest-profile bills is HR 1663, sponsored by Rep. Pete Stark (D-Calif.), who is well positioned to advance it as chair of the Subcommittee on Health. Among the range of additional mental health policy changes in the Stark bill are provisions to improve Medicare beneficiaries' access to mental health services provided by community-based residential and intensive outpatient mental health programs and to eliminate the 190-day lifetime cap on inpatient services in psychiatric hospitals.
"Because of these limitations, Medicare spending in mental health is skewed toward costly hospital services," Stark said, during the March hearing. "In 2001, 56 percent of mental health spending in Medicare went to inpatient care, which was over twice the national average of 24 percent. Conversely, the percentage of Medicare spending for cost-effective outpatient care is far below the national trend."
Chair Says MH Bill a Priority
Stark has introduced legislation in every Congress since 1995 that would provide some form of mental health and substance abuse parity in Medicare for inpatient and outpatient services. Although he has not yet scheduled a vote on the legislation, he describes it as a priority and said he was committed to it in a recent newsletter to his constituents. Another recently introduced bill (HR 1571), sponsored by Rep. Tim Murphy (R-Pa.), is focused on eliminating the differing Medicare copayment between mental health and other types of care. The bill would gradually lower the mental health outpatient copayment from 50 percent to 20 percent by 2013.
"Seniors who receive necessary mental health services" don't run up huge bills for hospital care, Murphy said, during comments on the House floor. For example, he said, "One hospital offered mental health services for elderly patients with fractures, and reduced the length of stay by two days and hospital costs by over $160,000."
APA Long Active on Access Issue
APA has long highlighted the need among Medicare beneficiaries increased access to mental health care. In addition to urging its members to register their support for bills such as Murphy's, APA has helped craft legislation in previous congressional sessions by Senators Olympia Snowe (R-Maine) and John Kerry (D-Mass.) to eliminate the copayment disparity (Psychiatric News, July 1, 2005).
Recent research continues to support the need for such legislation, including a 2006 George Washington University report that found 59 percent of disabled Medicare beneficiaries had a mental illness, and 37 percent had a mental illness classified as serious.
The 50 percent coinsurance requirement also is unfair to the nonelderly disabled Medicare population, according to its critics, because many Medicare beneficiaries have severe mental illness along with low incomes and high medical expenses. A 50 percent coinsurance requirement can create a serious burden among these low-income beneficiaries.
The higher copayment for outpatient psychiatric services has long been a feature of Medicare, and many efforts have tried unsuccessfully to lower it. The latest effort faces concerns over its potential costs, which come as Congress already is considering costly changes to Medicare. Another Medicare change APA supports would replace the physician reimbursement formula, which has scheduled steep cuts in coming years to control the program's increasing costs.
Ronald Manderscheid, Ph.D., the former chief of Mental Health Statistics and Informatics at the National Institute of Mental Health and the Substance Abuse and Mental Health Services Administration (SAMHSA), testified before the health subcommittee that he estimated Medicare's costs would increase "only slightly as a result of the proposed change." Once the higher cost for outpatient psychiatric care was lowered, he said, inpatient mental health care would decrease as outpatient care increased.
"Further, because many Medicare mental health service recipients are dual eligible for Medicaid, a change in Medicare is likely to have a salutary effect on Medicaid costs," he pointed out.
That a lowered copayment may result in other cost savings was echoed by other advocates for the change. David Shern, Ph.D., president and CEO of Mental Health America, testified that the limits on outpatient care in Medicare have resulted in much higher utilization of expensive inpatient care among Medicare beneficiaries than other populations.
A 2002 SAMHSA analysis found, for example, that Medicare beneficiaries were much more likely than Medicaid beneficiaries to receive inpatient mental health and substance abuse care, if they receive any such services at all, and that Medicare beneficiaries were less likely than Medicaid beneficiaries to receive mental health and substance abuse treatment in ambulatory outpatient facilities. When Medicare beneficiaries do receive inpatient care, according to the report, the care is more intensive, presumably because these individuals have not been able to access adequate outpatient care.
"Access to treatment through the Medicare program has long been restricted by outdated and discriminatory policies," Shern said.
Stark echoed the cost justification for a end to the discriminatory Medicare copayment by noting that Medicare mental health expenses have historically been heavily skewed toward more expensive inpatient services, with 56 percent of the program's mental health spending going to inpatient care and only 30 percent to outpatient services in 2001.
"This relationship is in contrast to national trends showing a reversal in inpatient and outpatient spending over the past decade," Stark said. Over the last 10 years, inpatient spending has declined from 40 percent to 24 percent, and outpatient spending has increased from 36 percent to 50 percent of all mental health spending, he noted.
Stark's bill (HR 1663) and Murphy's bill (HR 1571) can be accessed at <http://thomas.loc.gov> by searching on the bill number.
