DBSA Opposes CMS Proposal to Eliminate Access to Mental Health Treatments as Part of the "Six Protected Classes"In a misguided effort to save money, CMS proposal would deny vital treatments for people with mental health conditions who are covered under Medicare Part DChicago, IL (January 17, 2014)
On January 6, the Centers for Medicare and Medicaid Services (CMS) circulated a proposed rule that would remove antidepressants and immunosupressants from the protected class status they received under Medicare Part D in 2015, and to remove antipsychotics from that status in 2016. Despite a growing public recognition of America’s mental health treatment crisis, the Administration inexplicably proposed undoing one of Medicare’s signature protections for people with mental health conditions by suggesting that when it comes to drug treatment one size fits all.
“DBSA advocates for the right of people with mental health conditions like depression or bipolar disorder to choose their own paths to mental, emotional, and physical wellness,” stated Allen Doederlein, President of DBSA. “Implementation of this proposed ruling has the potential not only to undermine hard-won treatment advances a person with a mental health condition may have made, but also to undermine a person’s ability to choose the right treatment that a clinician identifies as the best fit for a serious, life-threatening condition.”
For nearly a decade, the “six protected class” policy has ensured that Medicare patients with mental health conditions, many of whom have severe, treatment-resistant symptoms, have access to the most appropriate drug without having to go through “fail-first” experiences or lengthy appeals and grievance processes. Often, delays caused by these processes can result in suicide and other tragic outcomes, and inadequate treatment leaves people open to relapse, co-occurring conditions which greatly shorten lifespans, and increased suicide risk.
Commenting on the proposed ruling, Joseph R. Calabrese, MD, Director, Mood Disorders Program, Bipolar Dis. Research Chair & Professor of Psychiatry and Dir. Bipolar Disorders Research Center at Case Western Reserve University, stated “the effectiveness and tolerability of antidepressants can vary greatly among people who choose this treatment option. Our extensive clinical experience demonstrates that the best therapy for one person may be ineffective or poorly tolerated in another individual. Moreover, successful treatment frequently involves trial of several different medications in a quest to find the best treatment in terms of efficacy and tolerability. As a result, it is important that people with mental health conditions have access to a wide variety of treatments and that clear information about these options is available both to clinicians and the individuals they serve and treat.”
We understand that the Administration's proposal represents an effort to save money. However, CMS has clearly failed to anticipate the predictable increase in costs to both Medicaid and Medicare Part A from the resulting spike in inpatient admissions. The Depression and Bipolar Support Alliance strongly opposes this proposed rule and is joining other stakeholders in the fight against it. These activities include submitting comments to the regulatory rulemaking process which are due on March 7.
Background: In 2005, CMS directed that Part D formularies include all or substantially all drugs in six drug classes, including: antidepressant; antipsychotic; anticonvulsant; immunosuppressant (to prevent rejection of organ transplants); antiretroviral (for the treatment of infection by retroviruses, primarily human immunodeficiency virus (HIV); and antineoplastic. The Medicare Improvements for Patients and Providers Act created the six protected classes, and the Affordable Care Act also defined them by name. Today, Medicare Part D plans must carry "all or substantially all" of the chemically distinct drugs in these categories on their formularies. For other categories, the plans can typically carry one brand-name drug and one generic drug.
A big step backward into the future: mental health “reform” Washington style
The new mental health reform bill introduced by Rep Murphy provides for the following according to the Treatment Advocacy Center:
" Requires states to have commitment criteria broader than “dangerousness” and to authorize assisted outpatient treatment (AOT) in order to receive Community Mental Health Service Block Grant funds.
Allocates $15 million for a federal AOT block grant program to fund to 50 grants per year for new local AOT programs.
Carves out an exemption in HIPAA (Health Insurance Portability and Accountability Act) allowing a “caregiver” to receive protected health information when a mental health care provider reasonably believes disclosure to the caregiver is necessary to protect the health, safety or welfare of the patient or the safety of another. (The definition of “caregiver” includes immediate family members.)"
What does it mean?
1. States will be substantially limited in their control over their own mental health policy. This, in and of itself, represents a radical change of immense implications. It is a wall once breached that will never be rolled back.
2. The future direction of mental health policy will basically be in the hands of the Treatment Advocacy Center. After years and years of failing to get states to follow their policy of coercion first to the degree they want their view would effectively become federal policy. What they could never win by choice they will win by force.
3. Much gains in knowledge about what really works and helps people with mental health issues would be rendered unimportant and out of fashion. The notion of recovery would be given a death blow.
4. States by federal statute would have to agree to commit more and more people.
5. Failure to do so would make you ineligible for federal block grants that are the backbone of so many state mental health budgets.
6. Privacy laws would not allow so much privacy. Confidentiality would have holes big enough to drive a hole through.
And that is only the beginning. It is a step back into an era of mental health care that was a national disgrace and one in which a diagnosis of mental illness was a life sentence.
Larry Drain recently joined in to pressure the elected officials to seriously consider the consequences of their actions upon the most vulnerable consumers of Tennessee. I ask that you join me in reading his blog and giving serious consideration to what we need to do and individuals to right a wrong. Thank you.
New post on Hopeworks Community
A place to go…. a plea for peer support
by Larry Drain, hopeworkscommunity.com
All of us need a place to go. We need a place that
provides the resources, the relationships, the support and the experiences that
give us a chance to lead lives of purpose, dignity , and meaning. That place is
different for everyone. Without it life seems never what to be what we want or
hope for. Instead pain and disappointment define our days. Life is a never
ending source of deprivation and opportunity seems reserved for other
For many people with serious mental health issues that place has
come to be their local peer support center. Counseling and medication may be
helpful to them, but neither is sufficient for them to have a realistic chance
at a successful, stable life in the community. They need a lived experience with
other people who have dealt with the same challenges they have, a lived
experience with others who have found that life can be better, that what you
know and practice makes a difference, a lived experience with others who show
that it is possible and needed to take control of their own life and be
responsible for their own choices. They need a lived experience in an
environment which shows them that not only do they have the opportunity to get
but the ability to give in a meaningful fashion, an experience that not only do
they count, but that they can be counted upon. Many of them have been in and out
of psychiatric institutions most of their life. Disruptions and problems have
marked their entire life and they may never have known the stability in living
essential to some measure of happiness and feeling of personal
Peer support centers have been their safe place. It has
given their lives the impetus that has allowed them to function successfully in
the community many for the first time. Many of them have no insurance or
financial resources and peer support centers are the only place they even have
access to. If you are poor and have serious mental health issues you have very
few places in this state to turn to for help. Peer support centers are one
essential life line.
The proposal to cut peer support funding puts all
this in jeopardy. Peer support centers radically improve the quality of the
lives of the people that go there. They improve the quality of the communities
they are located in. They do not meet the needs of everyone, but the people they
do meet the needs of normally have little where else to go. They give you much
more bang for your back than many much more expensive options. They keep people
out of psychiatric hospitals whose experience in hospitals is that they cant
make it anywhere else.
Peer support centers are a kindness to people who
have very little kindness in their lives. Before you take that kindness away
consider not the savings, but the costs. Think about the costs measured not in
numbers, but just in misery. We all need a place to go that matters.
In the overall scheme of things the money that will be saved by cutting peer
support centers is small potatoes. The gain of keeping them open at present
levels is immeasurable.
Please give us a place to go. Support peer support centers.
hopeworkscommunity | November 20, 2013
Veterans and the New Health Care Law
Week of October 21, 2013 Military.Com
The Department of Veterans Affairs (VA) sent out a letter a few weeks ago to veterans explaining their options under the Affordable Care Act (ACA). The new law will not change VA benefits. If a veteran is enrolled in VA healthcare, that coverage meets the standards for the ACA's insurance requirement. Most uninsured veterans are eligible for VA health care. However, not everyone who has served in uniform qualifies for VA health care such as Reserve or National Guard vets who served on active duty for training purposes only. Veterans who are not eligible for VA, and their families, could go to the Health Insurance Exchange. Another option, gaining Medicaid coverage, is limited in states that are not expanding the program. Here are some ways to enroll in VA care or determine your eligibility: (1) visit www.va.gov/healthbenefits/enroll; (2) call 1-877-222-VETS(8387); and (3) visit your local VA health care facility. For more information, visit VA, the Affordable Care Act and You webpage at www.va.gov/health/aca/.
For more updates on VA benefits programs, visit the Military Advantage blog.
S.L. Brannon D.Div..