by Kathie Garrett 

This is the fiscal year 2016 appropriation to the Department of Health and Welfare for the divisions of Mental Health Services, Psychiatric Hospitalization, and Substance Abuse Treatment and Prevention. It appropriates $48,970,900 from the General Fund, $12,106,700 from dedicated funds, and $26,929,500 from federal funds, for a total of $88,007,100 and 673 FTP for the three divisions.

Mental Health Services includes the Adult Mental Health and Children's Mental Health programs. Enhancements to this division include: $1,720,000 for a Behavioral Health Community Crisis Center to be located in North Idaho; a restoration of funding that was removed during the recession for services related to the Allumbaugh House, which is a partner with the state to meet the behavioral health needs of Idahoans in Southwest Idaho; and an additional 3.18 FTP. The bill includes intent language related to the location of the crisis center and states that the center will be located in Region 1 or Region 2. Psychiatric Hospitalization includes the Community Hospitalization, State Hospital North (SHN), and State Hospital South (SHS) programs. Changes to this division include $103,700 for

inflationary adjustments; $510,500 for various replacement items and alteration and repair projects  t the state hospitls, which includes $140,000 for SHS and $370,500 for SHS; and endowment fund adjustments that reduce the reliance on the General Fund by $649,800. The division was approved for five line items. The first is line item 4 that provides funding to the Community Hospitalization Program to account for the increased rates that the state will pay private hospitals that treat patients committed to the state until a bed is available at SHS or SHN. The second is line item 24 that provides funding for a nurse call system interface at SHS that will improve staff and patient safety. The third is line item 25 that provides SHS funding to upgrade its computer system for inventory management. The fourth is line item 26 that provides funding for a clinical notes template computer module for both SHN and SHS. This module will improve patient safety and billing processes. The final line item 32 adds 0.67 FTP to SHN.  Substance Abuse Prevention and Treatment included maintenance level adjustments for staff personnel costs.

Overall budget increase of 4.8%.  Signed  into Law by the Governor

Medicaid Mental Health Managed Care-Optum Contract

There was a lot of discussion around this issue.  The Optum team provided the House and Senate Health and Welfare Committees an update.  The Health and Welfare Joint Committees held public testimony and heard from over 22 people about their concerns. The Consortium for Idahoans with Disabilities, including NAMI Idaho,  met with Senator Heider, leaders from Health and Welfare  and Optum.  CID shared their concerns and asked Optum to respond back to their questions in writing.   Optum provided the answers in writing to the questions asked but most answers gave general philosophy.   CID  is still having discussion on this issue.

The Joint Legislative Oversight Committee voted unanimously to have the Office of Performance Evaluation conduct an extensive evaluation of the contract and its services and report back to the Legislature prior to next Legislative session.  The CID group (including NAMI Idaho) met with most of the Legislators serving on the JLOC committee to provide the information on the need of such a study and encouraged their vote.  Many Legislators mentioned  about how they had heard from many of their constituents about concerns about their lack of Medicaid services under Optum.

The JLOC committee voted unanimously to study the Optum Contract

Medicaid Expansion, Close the Gap

Despite the hard work of the Close the Gap Coalition (including NAMI Idaho), no legislation to expand Medicaid was presented.   The Speaker of the House had told the coalition there would not be a hearing on Legislation until they could guarantee enough Republican votes to pass it.   There was hope that with the support of Idaho's big business lobby (IACI) to carry the legislation that it would pass this year. Unfortunately IACI lost some of its political clout when a negative email was made public from the ICAI Executive Director.

by Kathie Garrett

The National Alliance on Mental Illness has just released a report on Mental Health Parity entitled  A Long Road Ahead - Achieving True Parity in Mental Health and Substance Use Care.  For too long, people who need mental health and substance use care have been subjected to

pervasive discrimination in health insurance.

This report describes a survey conducted by NAMI to assess the experiences of people living with mental illness and their families with of the survey are supplemented with an analysis of 84 health plans in the top 15 states by projected 2014 exchange enrollment. Their  findings

reveal that while progress is being  made in law, we have a long way to go to achieve true parity in mental health and substance use care. The report describes a number of barriers that people with mental illness and substance use disorders encounter in their efforts to obtain quality care.

Two laws passed by Congress has attempted to solve this decimation.  In 2008, Congress passed Paul Wellstone and Pete Domenici's Mental Health Parity and Addiction Equity Act (MHPAEA), requiring large group employer plans that offer mental health benefits to provide those benefits on par with other medical or surgical benefits. In 2010, Congress passed the Patient Protection and Affordable Care Act (ACA), which included mental health benefits as one of ten essential health benefits that must be included in qualified health plans sold both inside and outside the health insurance exchange or marketplace. In addition, the ACA extended MHPAEA to small group and individual health plans. 

The report found that  despite passage of these  landmark law, people with these disorders still face pervasive barriers in accessing needed care.   These barriers include:

• Denial rates for inpatient and outpatient MH care that are more than twice those for other types of medical care;
• Limits in access to needed psychiatric medications, particularly antipsychotic medications;
• Serious shortages of psychiatrists, therapists and other MH professionals in health insurance networks;
• High out of pocket costs (co-pays, deductibles, co-insurance); and
• Lack of information necessary to make informed decisions about plans.

To address these problems, NAMI is calling for:

• Strong federal and state enforcement of MHPAEA including;
  • Easily accessible mechanisms for filing complaints;
  • Monitoring and reporting on non-compliance by federal agencies responsible for enforcement (DOL, HHS);
• Publication by insurers of accurate, up to date lists of providers participating in health insurance networks;
• Also require insurance companies to publish;
  • Clinical criteria used to approve or deny mental health and SU care;
  • Clear, easily understandable info about plan benefits, including specific mental health and SU services covered.
• Congress and Administration should work together to decrease out of pocket costs for low income consumers in ACA plans. 

The findings of this report shows that much remains to be done to place mental health and substance use benefits on equal footing with other types of care.  NAMI Idaho is discussing how best to evaluate what is happening in Idaho related to parity and what strategies they should adopt.

The full report can be found at www.nami.org/parityreport.   

March 31, 2015

Southeast Idaho - Pocatello

NAMI Southeast Idaho held an open house for graduates of several years Family to Family classes on December 4th.  We had holiday refreshments and music and it was fun to touch bases with past graduates.  We do this every year.

On January 13th we will be having a table with information at the Fort Hall Convention Center in their new hotel.