STATEMENT: The Indiana General Assembly passed mental health
reform legislation in 1994 that has been looked on nationally as
a legislative blue print for mental health and addiction services.
The success or failure of the Hoosier Assurance Plan rests with
its implementation and funding. The actuarial conducted as required
by statute quantified the tremendous need for additional resources
and funding for both mental health and addictions for all ages.
The Mental Health America of Indiana will support the funding
levels required to ensure proper implementation of the Hoosier
Assurance Plan.
STATEMENT: The manner in which the state bureaucracy, which
provides government services to persons with mental illness, is
organized is critical to its service provision. FSSA was created
to better coordinate government policies and services. As a result
of the reorganization, the Division of Mental Health and Addictions
has lost a great deal of authority over its budget and policymaking.
Decisions are sometimes made without the expertise of DMHA.
MHAI supports organizational changes such that DMHA retains greater
authority over its budget and policymaking, and any reorganization
would place DMHA at a peer level with DOH and Medicaid as independent
agencies or in one umbrella health agency.
ISSUE: PROVISION FOR ADVANCED
DIRECTIVES IN MENTAL HEALTH CARE
STATEMENT: Recent changes in legislation in many states
give persons the right to specify, in advance, choices about how
they will be treated in the event that their illness renders them
incapable of exercising choice. The mechanisms for indicating choice
are forms of "advance directives". Advance directives
involve creation of legal documents during the time when an illness
is not severe enough to impair judgment. The documents can: 1)
specify consumer choices for treatment parameters (referred to
as "instruction directives"), and/or 2) designate a durable
power of attorney for medical decisions - a proxy - who is legally
authorized to make choices on behalf of the person who has the
impaired decisional capacity (referred to as proxy directives.)
The Mental Health America of Indiana supports the positive changes that have
been occurring in the public mental health care system throughout the country
that relate to a philosophy of providing care that empowers consumers to
be participants in their treatment, and to participate in the planning and
operation of the public mental healthcare system.
STATEMENT: Individuals who require guardianship services,
but cannot afford to pay for the service, can access Indiana's
Adult Guardianship Program. Currently there is a waiting list of
individuals who are in the community and in need of guardianship
services.
MHAI will support efforts to increase funding so as to eliminate
the waiting list for Guardianship services.
STATEMENT: Access to medications is imperative for people
with serious mental illness. Due to research in the last decade,
new medications have been developed that can have better outcomes
and fewer side effects for individuals with serious mental illness.
Studies have shown that by saving money on drug costs and changing
medications from newer to older, states have spent more money on
costly services such as crisis care and hospital services in the
long run. In the process, quality of life for individuals is impaired
and the individual may not fully recover to the functioning level
that they had achieved after switching medications solely for the
purpose of saving money.
The Mental Health America of Indiana will work to ensure that
persons with mental illness have access to the most appropriate
medications, whether they are provided by Medicaid, DMHA, DOC,
private insurance, or by any other payer source or in any other
treatment setting.
STATEMENT: Mental health, addictions and corrections issues
often overlap and persons with mental illness and/or addictive
disorders fall through the cracks in our criminal justice system.
The system itself does not recognize mental health or addictions
as an important issue that must be understood and treated. Police
and correction officers receive little or no mental health and
addictions training. Little use is made of community diversion
programs and our correction facilities are inadequate for persons
with a mental illness or addictive disorder.
MHAI will advocate for a comprehensive change in our system so
as to provide for a continuum of mental health and addictions treatment
for forensic patients, both juveniles and adults. The continuum
must include: a statewide diversion program for individuals charged
with misdemeanors and non-violent class "D" felonies;
a statewide community corrections program with a mental health
and addiction treatment component; and a forensic facility designed
to treat forensic patients. Further, police and correction officers
must receive adequate mental health and addictions education and
programming.
STATEMENT: Full health insurance coverage is typically
available to provide coverage for patients with diabetes or cancer,
and now for persons who have been diagnosed with a mental illness.
While SAMHSA studies show the cost of substance abuse parity to
be minimal, the Indiana legislature has supported the concept for
only state employees.
MHAI will work for full substance abuse parity legislation that
prohibits the discrimination of insurance coverage against persons
in need of treatment for substance abuse, who have insurance through
the private sector.
STATEMENT: Mental heath and addictions treatment is significantly
under funded in Indiana. MHAI supports additional alcohol taxes
and other relevant revenue sources and recommends that a portion
of this additional funding be utilized to support mental health
and addictions treatment services. MHAI further recommends that
a significant amount of these funds be allocated to address these
already identified gaps in addictions services: detoxification,
residential, adolescent, vocational rehabilitation, women and children,
and compulsive gambling, as well as SMI, and SED services.
If you would like to receive our actiongrams by
mail or by electronic-mail please contact Tiffany Peek at
tpeek@mhai.net
ActionGram February 2003
MHAI Passes Legislative Priorities!
In a legislative Session that was almost "cursed" by
a lack of funds, a poor economy, absent legislators' due to illness
and even the untimely death of one of its members, MHAI took significant
steps forward with key legislation. 150 legislators filed 1,605
bills and resolutions this year, with 520 moving to the opposite
chamber and only 140 bills moving to the Governor. While the number
of bills passed is significantly smaller than is typical for a
long session, MHAI passed a number of bills with significant reforms
in the area of mental health and addictions.
SUBSTANCE ABUSE PARITY
HB 1135 received a great deal of attention and is one of only two insurance
mandates to make it through this Session. HB 1135 would require insurance
companies to offer substance abuse parity insurance coverage whenever mental
health coverage is offered. This bill was hard fought in both the House and
the Senate with many legislative "heroes" needed to get this bill
passed. HB 1135 tied in the Senate on a 24 to 24 vote, only to give advocates
three days to resurrect the bill for a final attempt. In what became an effort
of high drama, with fierce opposition, the bill passed the second time with
only one "extra" vote. Again, many thanks go to our authors, Representative
Charlie Brown and Senator Connie Lawson, who fought hard so that individuals
with addictive disorders could receive the treatment they require.
FORENSICS
HB 1001, the Budget Bill, includes a forensic diversion program for adults
with mental illness and addictive disorders to receive community based treatment
or other services instead of incarceration. The provision requires the court
to take judicial notice of the fact that proper early intervention, medical,
advisory, or rehabilitative treatment of the individual is likely to decrease
the individual's tendency to engage in antisocial behavior when the individual's
mental illness or substance abuse is a contributing factor. In addiction,
the Department of Corrections is to present a report to the Budget Committee
regarding county sentencing patterns that will include: population, location
by facility, percentage of facility usage, type of inmate, type of incarceration,
mental health diversion, community corrections and community transition.
This provision is a beginning to looking at treatment for individuals
with mental illness and addictive disorders as an alternative to
incarceration and is an outgrowth of the conference MHAI hosted
last December on Forensic Reforms.
ACCESS TO MEDICATIONS
The Budget Bill was not kind to Medicaid which saw its line-item flat-lined.
At a time when national estimates put Medicaid growth at 13% and an economy
that will see more
recipients added to the rolls, Medicaid will effectively see a cut in the amount
of $574 million. Further, cuts that are made from Medicaid's 32 Optional Services
are to be made on a pro rata basis, with pharmacy services potentially taking
the largest cut. Given this proposal, access to mental health medications would
be again at risk, as these make up 13 of Medicaid's 25 top drugs in terms of
cost to the system.
HB 1458, built on the progress we made last year in protecting
Mental Health Medications. A complicated and hard fought bill will
continue to protect access to mental health medications and will
now require Medicaid to follow a clinically based process when
attempting to place limits on mental health medications to prevent
fraud, abuse, and inappropriate utilization. The process requires
that any limit is data driven, that educational provisions must
be tried initially, and that--in the end--the prescribing physician
will have the final say.
MENTAL HEALTH COMMISSION
Over the years, many of the mental health and addiction reforms presented to
the Indiana General Assembly began in the Indiana Mental Health Commission.
This Commission was set to expire, but will continue as a result of HB 1701.
We will now begin to make plans for the upcoming Session and present those
proposals to the Mental Health Commission in the summer.
THANKS!
A word of thanks must be extended to all who made this such a successful Session
in such a difficult year. We had an excellent staff lobby team with strong
Board support-in particular our Chairman, who worked in the halls throughout
the Session. We had the support of our Chapters and Subsidiary members, as
well as our allied advocacy organizations, who wrote many letters and made
many calls to their legislators. Finally, we must thank the legislators who
made this session possible-and their were many. MHAI's Legislative Honor
Roll will recognize legislators in 2003 who not only supported our issues,
but fought for our cause-every step of the way. Members of the 2003 MHAI
Legislative Honor Roll include: Representatives Vaneta Becker, Bill Crawford,
Scott Reske and Senators Billie Breaux, Bob Meeks, Pat Miller and Vi Simpson-but
no one did more than Representative Charlie Brown and Senator Connie Lawson,
both of whom will be presented MHAI's 2003 Susan R Crosby Legislator of the
Year Award!
Congratulations to All!
Mental Health and Addictions Rally
at the Statehouse
There is great uncertainty at the Legislature. The budget and the economy
approach a crisis situation. The legislature must make cuts, and mental
health and addiction services are at risk. A possible solution includes
raising the alcohol tax to pay for additional services, but there are strong
opponents to this idea with deep pockets. Substance Abuse Parity is being
considered as is a comprehensive Forensic proposal, focusing Indiana on
treatment and alternatives to incarceration. But these proposals will not
be successful unless your voice is heard!
Please take time out of your schedule to attend a Rally at the Statehouse
to Support Mental Health and Addictions. The Rally will be held on:
Tuesday, February 25, 2003 At 2pm
North Atrium of the Statehouse (Capitol and Washington)
Please come and bring your family and friends, as we need over 1000 advocates
to attend! If you plan to attend or have any questions, please contact Tiffany
Peek at (800) 555-MHAI or tpeek@mhai.net.
We approach the 2003 session of the Indiana General Assembly with much uncertainty.
This session is the "long" session where members of the legislative
body craft the budget for the next biennium. Several factors will make
this session especially challenging for the Mental Health America of Indiana,
Inc. Many of those who have historically led the fight in the Legislature
for Mental Health and Addictions reform are no longer our advocates inside
the Chamber. Gloria Goeglein has passed. Susan Crosby is now the Deputy
Director of Women in Government. Steve Johnson is a lobbyist. Mark Blade
was unsuccessful in his primary reelection effort. Further, there is much
uncertainty in state government as well. The Budget is in a state of crisis,
the Democrats in the House have a new Speaker and Chair of Ways and Means,
and the Governor is a lame duck. With that backdrop, the Mental Health
America of Indiana has developed an ambitious public policy agenda. We
must look to new leadership, both within the Indiana General Assembly as
well as the Association to be successful.
MHAI Priority Bills are: ADDICTIONS HB1135 Coverage for substance abuse services. Provides
that mental health coverage provided under accident and sickness
insurance policies and contracts with health maintenance organizations
must include coverage of services for the treatment of substance
abuse and chemical dependency when required in treatment of
a mental illness. Author: Charlie Brown 01/07/2003 H: 1st Reading
Assigned Insurance, Corporations And Small Business 01/27/2003
H: Committee Sched 10:30 a.m. Room 156B Insurance, Corporations
And Small Business.
MENTAL HEALTH SB0064 Psychiatric advance directives. Authorizes the execution of
a psychiatric advance directive (a medical directive that directs the administration
of or refuses psychiatric re stabilization for the care and treatment of
an individual's mental illness). Requires a psychiatrist, a health care provider,
emergency medical service personnel, or a health care facility to comply
with a psychiatric advanced directive. Provides that a person is not subject
to civil or criminal liability for complying in good faith with a psychiatric
advance directive. (The introduced version of this bill was prepared by the
commission on mental health.) Author: Connie Lawson 01/07/2003 S: Author
Added Connie Lawson 01/07/2003 S: 1st Reading Assigned Health And Provider
Services
FORENSICS SB0155 Department of correction mental health drugs. Allows
a department of correction offender to be prescribed mental health
drugs that are available to a Medicaid recipient. (The introduced version
of this bill was prepared by the Indiana commission on mental health.)
Author: Connie Lawson 01/07/2003 S: Author Added Connie Lawson 01/07/2003
S: 1st Reading Assigned Health And Provider Services SB0476 Community
corrections and the mentally ill. Author: Connie
Lawson Bills of interest to MHAI include: FORENSICS HB1082 Withholding judgment of conviction. Provides that
in certain circumstances, a court may withhold judgment of conviction.
Author: Jonathon Weinzapfel 01/07/2003 H: 1st Reading Assigned
Courts And Criminal Code HB1104 Alcohol and drug services program. Extends the alcohol
and drug services program to persons accused of infractions. Author:
James L. Bottorff 01/07/2003 H: 1st Reading Assigned Courts And
Criminal Code HB1252 Community corrections goals and statistics. Requires
state and locally operated community corrections
programs to report to the legislative services agency
the race, ethnicity, and communicable disease carrier
status of offenders in the programs. Adds the reintegration
of offenders into the community as a purpose for
the establishment and operation of community corrections
programs. Author: Vernon G. Smith 01/22/2003 H: Committee
Sched 1:30 p.m. Room 156D Human Affairs HB1260 Withholding judgment of conviction. Allows
a court to withhold judgment of conviction for a
Class D felony under certain circumstances. Author:
Dennis T. Avery 01/13/2003 H: 1st Reading Assigned
Courts And Criminal Code HB1402 Reduction or suspension of sentences. Allows
a court to modify a defendant's sentence without
the approval of a prosecuting attorney and place
the defendant in a community corrections program:
(1) if, when sentencing the defendant, the court
could have placed the defendant in a community corrections
program as an alternative to commitment to the department
of correction; and (2) regardless of when the original
sentencing hearing was conducted. Author: Vernon
G. Smith 01/14/2003 H: 1st Reading Assigned Courts
And Criminal Code HB1404 Drug treatment programs. Allows a person
who is committed to the Department of correction
to receive drug addiction treatment. Author: Vernon
G. Smith 01/14/2003 H: 1st Reading Assigned Human
Affairs HB1446 Offenders on home detention. Requires
constant supervision of Violent offenders and flight
risks on home detention. Requires Development of
written criteria and procedures to determine if an
offender placed on home detention is a violent offender
or flight risk. Requires an entity monitoring An
offender to: (1) provide local law enforcement agencies
with information indicating whether an offender on
home detention is an offender or a flight risk; (2)
forward a photograph of the offender to local law
enforcement; and (3) immediately contact a local
law enforcement agency if the offender violates a
condition of home detention. Author: Scott Reske
01/14/2003 H: 1st Reading Assigned Human Affairs HB1532 Community corrections officers. Requires
the department of correction to establish educational,
occupational, and salary requirements for community
corrections field officers. Establishes the duties
of a community corrections field officer. Includes
community corrections field officer in the definition
of public safety officer for purposes of the law
concerning regulation of laser pointers. Author:
Terry A. Goodin 01/16/2003 H: 1st Reading Assigned
Human Affairs HB1766 Direct placement in community corrections. Permits
an individual convicted of operating while intoxicated
with two prior unrelated convictions to be placed
directly in a community corrections program. Author:
Kathy Kreag Richardson 01/21/2003 H: 1st Reading
Assigned Judiciary HB1785 Reentry court program. Permits certain
drug offenders participating in the Allen County
reentry court program to receive food stamps or temporary
assistance for needy families (TANF). Author: Winfield
C. Moses, Jr. 01/21/2003 H: 1st Reading Assigned
Human Affairs SB0099 Alcohol abuse and bail. Permits a court
to require a defendant to receive deterrent treatment
for alcohol abuse as a condition of bail when the
defendant's use of alcohol contributed to the offense
and the defendant's continued use of alcohol may
pose a risk of physical danger. Author: Thomas J.
Wyss 01/07/2003 S: 1st Reading Assigned Judiciary SB0247 Addiction services and drug courts. Specifies
that, under the law concerning addiction services,
an alcohol and drug services program includes services
for persons charged with or found to have committed
infractions. Allows a drug court to accept an eligible
individual who is referred from or whose case is
transferred from another court located in the same
county as the drug court. Removes an incorrect reference
concerning adoption of rules in the law that allows
the Indiana judicial center to adopt rules concerning
drug courts. Provides that, when a person referred
to a drug court: (1) has the person's participation
in th e drug cou rt terminated, the drug court must
enter a judgment of conviction against the person
or refer the case back to the originating court so
that court may enter a judgment of conviction; and
(2) fulfills the conditions established by the drug
court, the drug court must dismiss the charges against
the person or refer the case back to the originating
court so that court may dismiss the charges. Author:
John E. Broden Author: Thomas J. Wyss 01/09/2003
S: 1st Reading Assigned Judiciary
FSSA HB1134 Performance audit of FSSA. Requires
the legislative evaluation and oversight policy subcommittee
to direct staff in performing an audit of the organizational
structure of the office of the secretary of family
and social services (office) in 2003. Requires the
office to cooperate with the subcommittee and provide
specified information for the study. Requires the
chairman of the legislative council to appoint a
committee in 2004 to perform specified duties. (The
introduced version of this bill was prepared by the
health finance commission.) Author: Charlie Brown
01/21/2003 H: 2nd Reading Pass HB1701 Various FSSA matters. Reauthorizes
the office of the secretary of family and social
service's administrative structure until January
1, 2006. Establishes the bureau of quality improvement
services within the division of disability, aging,
and rehabilitative services (division) to: (1) monitor
certain services; ( 2) assist with quality assurance
activities of other bureaus within t he division;
and (3) establish a complaint process for individuals,
providers, and case managers. Allows: (1) the family
and social services committee to vote to place proposed
rules on the consent calendar; (2) the secretary
or a division director who adopts a propos ed rule
that was o n the consent calendar in identical form
except for technical changes to adopt the rule without
resubmitting the rule to the committee; and (3) the
committee to take action on a rule that is not on
the consent calendar by the affirmative vote of a
majority of the committee present and voting. Requires
the coroner to make available the full copy of an
autopsy report to the division or the division of
mental health and addiction under specified circumstances.
Author: Charlie Brown 01/21/2003 H: 1st Reading Assigned
Public Health SB0057 Performance audit of FSSA. Requires
the legislative evaluation and oversight policy subcommittee
to direct staff in performing an audit of the organizational
structure of the office of the secretary of family
and social services (office) in 2003. Requires the
office to cooperate with the subcommittee and provide
specified information for the study. Requires the
chairman of the legislative council to appoint a
committee in 2004 to perform specified duties. (The
introduced version of this bill was prepared by the
health finance commission.) Author: Gregory D. Server
01/21/2003 S: 2nd Reading Pass
ADDICTIONS HB1141 Moratorium on methadone clinics. Extends the
state imposed moratorium on methadone clinics until July 1,
2008. Sets the dates that reports from methadone providers
are due to the division of mental health and addiction. Author:
Charlie Brown 01/15/2003 H: Committee Sched 10:00 a.m. Room
House Chamber Public Health HB1389 Methadone clinics. Prohibits a methadone provider
from operating in a county with a population of less than 50,000.
Author: Robert J. Bischoff 01/14/2003 H: 1st Reading Assigned
Public Health HB1390 Methadone clinics approved by county commissioners. Permits
a methadone provider t o operate in a county with a population
of less than 50,000 only with the approval of the county's
board of county commissioners. Author: Robert J. Bischoff
01/14/2003 H: 1st Reading Assigned Public Health HB1391 Methadone clinic certification. Prohibits
the division of mental health from certifying a methadone
provider to operate in a county with a population
of less than 50,000. Author: Robert J. Bischoff 01/14/2003
H: 1st Reading Assigned Public Health HB1626 Methamphetamine. Makes the possession
of one or more chemical reagents or precursors
with the intent to manufacture methamphetamine
a Class C felony. Increases the penalty to a Class
B felony if the person also possesses a firearm
or is within 1,000 feet of a school, public park,
housing complex, or youth center while committing
the crime. Prohibits the possession of ephedrine,
pseudoephedrine, or phenylpropanolamine with in
tent to manufacture methamphetamine. Establishes
a rebuttable presumption that a person (with certain
exceptions ) who possesses more than 24 grams of
ephedrine, pseudoephedrine, or phenylpropanolamine
intends to manufacture methamphetamine. Prohibits
the sale of chemical reagents or precursors to
a methamphetamine or other controlled substance
manufacturer. Makes it a Class C felony for a person
to purchase or rent a laboratory location for a
methamphetamine lab, or to use a vehicle to manufacture
methamphetamine, and requires the person to provide
restitution for the costs of cleaning up the illegal
laboratory. Provides a sentence enhancement of
five years if a person manufactures methamphetamine
in the presence of a child. Author: Edmund M. Mahern
01/16/2003 H: 1st Reading Assigned Courts And Criminal
Code HB1795 Methamphetamines. Classifies ephedrine,
pseudoephedrine, and phenylpropanolamine as legend
drugs. Author: Alan Chowning 01/21/2003 H: 1st Reading
Assigned Judiciary HB1801 Definition of grocery store. Defines "grocery
store" for alcoholic beverage statutes. Author:
Robert D. Kuzman 01/21/2003 H: 1st Reading Assigned
Public Policy, Ethics And Veterans Affairs SB0197 Moratorium on methadone clinics. Extends
the state imposed moratorium on methadone clinics
until July 1, 2008. Sets the dates that reports from
methadone providers are due to the division of mental
health and addiction. Author: Patricia L. Miller
01/15/2003 S: Committee Sched 9:00 a.m. Room 431
Health And Provider Services SB0317 Definition of grocery store. Defines "grocery
store" for alcoholic beverage statutes. Author:
Thomas J. Wyss Author: Billie J. Breaux 01/15/2003
S: 1st Reading Assigned Commerce And Consumer Affairs SB0377 Alcoholic beverage sales in grocery stores. Defines "grocery
store" and "major grocery store" for
purposes of the alcoholic beverages law. Provides
that the alcohol and tobacco commission may issue
a liquor dealer's permit for a major grocery store
located inside or outside the corporate limits of
a city or town. Specifies that a statutory disqualification
concerning the issuance of beer retailer permits
does not apply to a major grocery store. Specifies
that a drug store or a major grocery store may sell
any item through a window that is not an alcoholic
beverage. Author: Gregory D. Server Author: John
E. Broden 01/16/2003 S: 1st Reading Assigned Commerce
And Consumer Affairs SB0427 Penalty for providing alcohol to a minor. Author:
Rose Ann Antich 01/21/2003 S: Author Added Rose Ann
Antich
CHILDREN HB1188 ISTEP waiver for children with disabilities. Changes
certain requirements for a student with a disability
to receive a waiver to graduate from high school
without passing the graduation examination. Requires
a student who seeks a waiver to: (1) attain the goals
established by the student's individual educational
program rather than to attain the academic standard
in a subject area; and (2) maintain a passing grade
rather than a "C" average. Author: Russell
L. Stilwell 01/08/2003 H: 1st Reading Assigned Education
SB0015 Location of group homes. Permits zoning restrictions
that prevent a group home for developmentally disabled
individuals or mentally ill individuals from being
within 3,000 feet of another group home. Author:
Patricia L. Miller 01/07/2003 S: 1st Reading Assigned
Governmental Affairs and Interstate Cooperation SB0062 Commission on abused and neglected children. Establishes
a commission on abused and neglected children and
their families to develop a plan of services for
children at risk of abuse or neglect and for abused
or neglected children and their families. Requires
a report not later than August 15, 2004. (The introduced
version of this bill was prepared by the board for
the coordination of child care regulation.) Author:
Connie Lawson 01/16/2003 S: Committee Report amend
do pass, adopted SB0133 Children's mental health task force. Establishes
the children's mental health services collaboration
task force. Requires the task force to submit to
the legislative council before July 1, 2005, a comprehensive
plan for individuals with a mental illness who receive
special educational services. Author: Billie J. Breaux
01/07/2003 S: 1st Reading Assigned Health And Provider
Services
MENTAL HEALTH HB1258 Psychiatrist director of mental health
division. Requires the director of the mental
health division of the family and social services
administration to be a psychiatrist. Author: Dennis
T. Avery 01/13/2003 H: 1st Reading Assigned Appointments
And Claims HB1384 Bachelor social worker licensing degree. Provides
that a person who has a bachelor in social work degree
and meets certain other requirements may be licensed
as a bachelor social worker. Author: Robert J. Bischoff
01/14/2003 H: 1st Reading Assigned Commerce And Economic
Development HB1395 Mental health placement. Provides that
if the director of the division of mental health
and addiction decides that a final placement decision
is to be made for a mentally ill person, the decision
must be made by a licensed psychiatrist or psychologist
in consultation with the mentally ill person's psychiatrist
or psychologist. (The introduced version of this
bill was prepared by the health finance commission.)
Author: Vaneta Becker 01/14/2003 H: 1st Reading Assigned
Public Health HB1436 Review of mandated benefits. Requires
the department of insurance to report to the legislative
council an analysis of information filed by accident
and sickness insurers and health maintenance organizations
related to the effect of implementation of mandated
benefits. Author: Peggy Welch 01/14/2003 H: 1st Reading
Assigned Insurance, Corporations And Small Business HB1456 Tobacco settlement funds. Makes permanent
appropriations from the tobacco master settlement
agreement fund. Author: Charlie Brown 01/22/2003
H: Committee Sched 10:30 a.m. Room House Chamber
Public Health HB1458 Medicaid prescription drug waiver. Allows
the office of Medicaid policy and planning to limit
access to prescription drugs for prescription drug
program recipients to prevent fraud, abuse, waste,
overutilization, and inappropriate utilization. Author:
Charlie Brown 01/15/2003 H: 1st Reading Assigned
Public Health HB1688 Prescription Drug Program. Authorizes
the office of Medicaid policy and planning (office),
in consultation with the drug utilization review
board, to develop and implement a preferred drug
formulary. Sets out parameters of the preferred drug
formulary. Establishes the Rx program to provide
discounted prescription drug prices to Indiana residents
who are: (1) uninsured; (2) under insured; (3) Medicare
recipients; and (4) covered under insured or self-funded
employee welfare benefit plans that provide prescription
drug benefits. Allows a drug manufacturer or labeler
that sells prescription drugs to voluntarily enter
into a rebate agreement with the state department
of health that requires rebate payments to be made
to the state for the Rx program. Authorizes the state
department to negotiate the amount of the rebate
and audit a manufacturer or labeler to assure compliance.
Requires a retail pharmacy to sell the drugs covered
by the Rx program to participants in the Rx program
at the discounted price. Establishes: (1) a formula
for the state to use in calculating discount prices
for drugs covered by the rebate agreement; (2) a
procedure for resolving rebate amount discrepancies;
and (3) the Rx dedicated fund, consisting of revenue
from manufacturers and labelers who pay rebates and
appropriations to the fund. Author: Clyde Kersey
01/21/2003 H: 1st Reading Assigned Ways And Means HB1703 Medicaid preferred drug list. Allows
the office of Medicaid policy and planning to add
a drug that has been approved by the federal Food
and Drug Administration to the preferred drug list
without prior approval from the drug utilization
review board. Permits the board to add a drug that
has been approved by the federal Food and Drug Administration
to the preferred drug list. (Current law allows:
(1) the office to add only new single source drugs
to the preferred drug list without prior approval
of the board; and (2) the board to add only new single
source drugs to the preferred drug list.) Makes cross
references. Author: Charlie Brown 01/21/2003 H: 1st
Reading Assigned Public Health HB1726 Detention of minors violating alcohol laws. Provides
that a child alleged to be a delinquent child for
violating the laws concerning minors and alcoholic
beverages may be placed in a juvenile detention facility
for up to 48 hours. Requires the parent or guardian
of the child to reimburse the county for expenses
related to the placement of the child in a juvenile
detention facility. Author: Dan Leonard 01/21/2003
H: 1st Reading Assigned Human Affairs SB0121 Protection and advocacy services commission. Prohibits
a member of the protection and advocacy services
commission from serving more than five consecutive
terms. Author: Robert N. Jackman, D.V.M 01/07/2003
S: 1st Reading Assigned Criminal, Civil and Public
Policy SB0260 Waiver of preexisting conditions. Provides
that an individual policy of accident and sickness
insurance or a group policy of accident and sickness
insurance under which a certificate of coverage is
issued to an individual member of a nonemployer based
association or discretionary group may contain a
waiver of coverage for a specified condition under
certain circumstances. Specifies that an offer of
coverage under a policy that includes a waiver does
not preclude eligibility for a comprehensive health
insurance association policy. Author: Allen E. Paul
01/09/2003 S: 1st Reading Assigned Health And Provider
Services SB0281 Central State advisory committee. Reestablishes
the Central State advisory committee. Author: Patricia
L. Miller 01/15/2003 S: 1st Reading Assigned Health
And Provider Services SB0425 Civil commitment of sexual predators. SB0441 Insurance prescription drug disclosure. Author:
Marvin D. Riegsecker 01/21/2003 S: Author Added Marvin
D. Riegsecker SB0460 Eligibility of SSI recipient
for Medicaid. Author: Vi Simpson 01/21/2003 S:
Author Added Vi Simpson
In keeping with his commitment in his veto message last year, Governor Frank
O'Bannon signed into law HEA 1233, (Rep. Crosby, D-Roachdale) and (Sen. Gard,
R-Greenfield) which would insure that a Medicaid recipient in a fee-for-service
Medicaid program would not be restricted access to mental health drugs. This
bill replaces SEA 471, which overwhelming passed last Session, but was vetoed
by the Governor.
HEA 1233 is the strongest legislation of its kind in
the country and is being seen as a model for other states.
HEA 1233 had been overwhelmingly approved by both the Indiana
Mental Health Commission and the Medicaid Oversight Commission,
respectively. HEA 1233 recognizes that individuals with
mental illness must have access to the newer and typically more
appropriate medications to lead functional and productive lives.
It also reflects the research which shows that dollars spent on
more effective (and more costly) medications save more dollars
elsewhere in the state budget and in society as a whole.
Much thanks goes to the chapters and the members of the Mental
Health America of Indiana who worked so hard on this legislation
for so long. Thanks must also go to our sponsors, i.e., Representative
Susan Crosby and Senator Bev Gard as well
as Representative Charlie Brown and Senator
Pat Miller, who chair the House and Senate Health Committees.
We must also express appreciation to Eli Lilly and Company and
our other coalition supporters on this bill. Finally, we must express
our sincere gratitude to Melanie Bella, Director,
Office of Medicaid Policy and Planning, for her hard work in making
the Governor's commitment a reality.
In a related bill, SEA 228 (Miller, R-Indianapolis/Brown,
D-Gary), the Indiana General Assembly authorizes the
Office of Medicaid to create a Preferred Drug List (formulary)
in an effort to save costs. MHAI was able to insert language
that would insure that Mental Health Drugs as defined in HEA
1233 (above) would be on the Preferred Drug List, defining
and insuring "unrestricted access." In addition,
MHAI and other mental health advocates and providers were able
to exclude language that would have restricted the use of antipsychotic
medications in children in both the public and private sectors.
There will be an analysis of the prescribing patterns of stimulant
medications for children to ascertain whether there is inappropriate
utilization and whether any future action should be considered. HB
228 also prohibits the four script limit that had been
proposed by Medicaid as a cost saving measure.
Taken together, HEA 1233 and SEA 228 will insure
that mental health medications are not restricted in the fee-for-service
Medicaid program.
Addictions
HB 1004 (Bauer/Borst), would have made
a number of tax changes including providing an increase in the
cigarette and the admissions tax for gaming. At one point, consideration
was given to increasing the alcohol tax, thanks in large part to
the work of our subsidiary corporation, the Indiana Addictions
Issues Coalition. This bill FAILED and may be the subject
matter for a Special Session.
SB 279 (Johnson), would have provided for substance
abuse parity in the private sector. This bill did not receive a
hearing and FAILED as a result.
SB 97 (Gard/Brown), would provide for the tracking
of the seller and buyer of kegs of beer. PASSED!
Mental Health
HEA 1050 (Crosby/Johnson), would extend the expiration
of the Indiana Commission on Mental Health until January 1. 2004. PASSED!
SB 518 (Server/Crosby), would establish primary
service areas for community mental health centers for purposes
of receiving property tax revenue. Includes language that protects
consumer choice of service provider. PASSED!
Health Insurance
HB 1163 (Crooks) would have permitted health insurance
policies to waive coverage for up to two specified conditions.
The bill excluded mental health conditions as illnesses that could
be waived. FAILED.
RESOLUTIONS
HR 55 (Crosby) would require the Indiana Mental
Health Commission to study Psychiatric Advance Directives. PASSED!
HR 62 (Crosby) would require the Indiana Mental
Health Commission to study Guardianship funding. PASSED!
The Indiana General Assembly is concentrating on various tax
and budgetary issues in an attempt to alleviate the state's financial
crisis, leaving no interest or resources in new programs. While
the General Assembly's focus is limited this Session, there are
nonetheless bills that could have a lasting impact on persons
with mental illness. MHAI has focused its resources on bills
prioritized by the Board of Directors that are moving and have
a likely chance of passage. The following are the key bills of
interest:
Mental Health Medications
HB 1233 (Crosby) and SB 228 (Miller) would insure that a Medicaid
recipient in a fee for service Medicaid program would not be restricted
access to mental health drugs. These bills are attempts to replace
SEA 471 which overwhelming passed last Session, but was vetoed
by the Governor. The bills were overwhelmingly approved by both
the Indiana Mental Health Commission and the Medicaid Oversight
Commission, respectively. These bills recognize that individuals
with mental illness must have access to the newer and typically
more appropriate medications to lead functional and productive
lives. They also reflect the research which shows that dollars
spent on more effective (and more costly) medications save even
more dollars elsewhere in the state budget and for society as a
whole. HB 1233 passed out of the House Public Health Committee
unanimously. SB 228 passed out of Senate Health with an amendment
that would require the prior authorization of psychotropic medications
for children with ADHD. It would also require Medicaid to use a
Preferred Drug List. MHAI will be working to amend these sections.
Please call your Legislator and ask him/her to support HB 1233
and SB 228, Access to Mental Health Medications. You can call your
Representative at 800-382-9842 and your Senator at 800-382-9467.
Addictions
HB 1050 (Crosby),would extend the Indiana
Commission on Mental Health and change its name to the Indiana
Commission on Mental Health and Addictions. It would also add to
the Commission, the chair and ranking member of the House and Senate
Health Committees. This bill passed that House 92-3! HB 1004 (Bauer),would make a number of tax changes, including
providing an increase in the cigarette and the admissions tax for gaming.
This bill will be central to the Session! SB 279 (Johnson), would provide for substance abuse parity
in the private sector. This bill is not expected to get a hearing. SB 97 (Gard), would provide for the tracking of the
seller and buyer of kegs of beer. This bill has passed the
Senate 37-13!
Health Insurance
HB 1163 (Crooks) would permit health insurance
policies to waive coverage for up to two specified conditions.
The bill excludes mental health conditions as illnesses that can
be waived.
As we approach the 2002 Indiana General Assembly, mental health
advocates have reason to be hopeful, and at the same time, very
nervous. This will be a year where making mental health advances
will require the creation of statutory protections. The Indiana
state budget is in crisis and Medicaid plays a key role.
Within Medicaid, many view pharmacy as a cost driver, and mental
health medications as a leader in that area. Indeed, 12 of the
top 25 Medicaid drugs in terms of cost are mental health drugs.
On its face, a simplistic analysis would suggest that this is an
area where costs must be controlled. However, study after study
has shown that these drugs have actually reduced overall Medicaid
costs by reducing institutionalization. In fact, as costs for the
newer more appropriate medications have gone up, costs for hospitalization
have gone down--saving much more than the cost of the drugs.
Our challenge is to make policy-makers recognize that not only
would limiting the newer more appropriate mental health drugs hurt
mental health consumers, it would hurt the state budget as well.
One study conducted by the New England Journal of Medicine found
that limiting the newer medications for the treatment of schizophrenia,
actually resulted in an increase in state spending--17 fold.
Through our work with the administration, the Governor, the Secretary
of FSSA, and the Director of Medicaid have understood this, and
have agreed to promulgate a rule that prevents the prior authorization
and other limitations of mental health medications. They have also
agreed to work with us to enact the language of the rule into statute.
This bill would take the place of SEA 471, which would have protected
mental health drugs but was vetoed by the Governor last year.
A preliminary draft bill was unanimously endorsed by both the Mental Health
Commission and the Medicaid Oversight Commission.
Our job now is to convince the legislators. They are in an environment
where costs are spinning out of control and there will be much
pressure to do something--anything--maybe the wrong thing!
Please contact your Senator and your Representative and ask him/her
to support legislation to protect mental health medications from
prior authorization and other ill-advised limitations. You can
locate and contact your legislator by logging on to our website
at www. mentalhealthassociation.com
In a sharp turn of events, the Office of Medicaid Policy and Planning,
under the leadership of Melanie Bella, came to agreement with the
Mental Health America of Indiana on language that will insure that
mental health consumers receive the mental health drugs they require.
This is in keeping with Governor Frank O'Bannon's pledge in his
veto message to support a new rule and legislation to replace SEA
471.
After the 2001 Indiana General Assembly voted overwhelmingly to
pass SEA 471, which would have prevented Medicaid from limiting
access to consumers in need of critical mental health medications,
it was vetoed by the Governor.
In a letter to Stephen C. McCaffrey, President of MHAI, Governor
O'Bannon stated that he vetoed the bill even though he agreed that "the
new generation of antipsychotic and antidepressant medications
have offered new hope to persons suffering from severe mental illnesses.
In his letter, the Governor offered to "propose legislation
in the 2002 session of the Indiana General Assembly that will codify
the [a revised] rule into state law."
MHAI has in fact been in ongoing negotiations with the Office
of Medicaid Policy and Planning to draft language that would be
promulgated into rule and enacted into statute in the 2002 Session
of the Indiana General Assembly. It was only until the new state
Medicaid Director, Melanie Bella, intervened that progress was
possible.
Under the agreed upon language:
— Mental Health Medications will be broadly defined to
include antidepressants, antipsychotics, and antianxiety drugs.
The definition will include cross-indications, new drugs and
new drug categories, as they are discovered.
—Access to these critical medications will be unrestricted and prior authorization
can not be used.
— Brand name drugs will not be prior authorized in favor of generics so
as to save money.
— Limitations on these drugs will only be permitted to prevent fraud, abuse,
waste, and inappropriate utilization or to promote disease management. Even this
can only be done when it is in the best interest of the recipient and quality
of care is required.
This language is a victory for mental health consumers. It
symbolizes a recognition by policy-makers that mental health
medications have a unique place in the health arena.
This language will now be promulgated into rule and then will
be introduced as a bill in the 2001 Indiana General Assembly to
replace the language of SEA 471. It is important that you contact
your legislator and make sure that he/she supports this critical
legislation.
This new legislation is supported by the MHAI, the Office of Medicaid,
the Mental Health Commission, mental health advocates, consumers,
families, providers and professionals. It makes sense from both
a therapeutic and financial standpoint.
The Mental Health America of Indiana worked hard on this issue
during the last legislative session and during the interim reminding
legislators that with access to appropriate medications consumers
can stay out of state institutions and regain their lives in the
community. This would not be possible without access to the latest
medications. Research over the last 20 years has given new hope
to those people who have mental illness, who in the past were destined
to live a life of isolation in costly state institutions.
