Friday, July 31, 2009
Thursday, July 30, 2009
Monday, July 27, 2009
I'm still technically on vacation, so I haven't been as active the last few days. Apparently, the initial systems of care meetings are starting to happen. Anyone been to one yet? Another one is going on on Wednesday.
This is a reminder that the YOU,Inc CSA in collaboration with Harrington Hospital will be hosting the initial System of Care meeting for the South Central area on Wednesday July 29th from 4:30 - 6:00 PM at Harrington Hospital in Southbridge in Conference Room 1-2. Light refreshments will be provided.
We are looking forward to this kickoff to provide you with updates on the start of the CSA and introduce you to the staff who have been hired. We will also talk about the wraparound model and the principles it is based upon. We hope to have representatives from the Mobile Crisis Teams to update you on the development of those new services. We will also share any new updates on the CBHI system and new services for the Fall.
We are hoping that you will help us to shape the SOC and identify other people that are key players that should be invited to participate.This is an exciting project and look forward to collaborating with many community partners to support our efforts to develop this model. We particularly need your input due to the large geographic area we are covering and the many individual communities that exist within the South Central Area. This needs to be a community effort and you are being invited as a key member of this community. Thanks again and if you haven't already RSVP, please send me an email. Thanks and see you next week.
Thursday, July 23, 2009
Wednesday, July 22, 2009
Tuesday, July 21, 2009
Sunday, July 19, 2009
We recently received the great news that the House Education and Labor Committee passed an amendment that would guarantee children access to Early Periodic Screening, Diagnostic and Treatment (EPSDT) services — the standard benefits package under Medicaid — as part of any government-approved, Exchange-participating health plan. This is a priority that NEACH has been supporting throughout the health reform debate, and we are very happy to see that it will be included in the final House bill.
Two moderate Republicans, Michael Castle (R – DE) and Todd Platts (R – PA), joined Democrats to approve the amendment by a vote of 31-17. The amendment was introduced by Robert Scott (D – VA).
Saturday, July 18, 2009
Peter Metz, MD and the Communities of Care Project have been chosen to receive the American Academy of Child and Adolescent Psychiatry Rieger Service Award this year. This award recognizes innovative programs that address prevention, diagnosis, or treatment of mental illnesses in children and adolescents, and serve as model programs to the community. They will receive the award at the annual meeting in October, 2009. Guess where the AACAP is meeting this year? Honolulu, HI! What a perfect year to receive this award. Congratulations, Peter; well deserved.I can only echo this sentiment; well done, Peter.
Friday, July 17, 2009
Wednesday, July 15, 2009
Massachusetts Mental Health Parity Law
1. What is the Massachusetts Mental Health Parity Law?
The Massachusetts Mental Health Parity Law requires insurers who offer mental health benefits to cover the diagnosis and treatment of certain mental disorders to the same extent that they cover the diagnosis and treatment of physical disorders. The law makes it illegal for some health insurers to place stricter annual or lifetime dollar or unit of service limitations on coverage of qualifying mental disorders that differ from the limitations on coverage of physical conditions. The law also provides for minimum outpatient and inpatient benefits for those disorders not required to be treated the same as physical ailments.
2. What mental disorders must be given unlimited medically necessary treatment?
The Mental Health Parity Law provides parity for these disorders:
“Biologically-based” mental disorders
· Schizoaffective disorder
· Major depressive disorder
· Bipolar disorder
· Paranoia and other psychotic disorders
· Obsessive-compulsive disorder
· Panic disorder
· Delirium and dementia
· Affective disorders
· Any other "biologically-based" mental disorders appearing in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (the "DSM") that are scientifically recognized and approved by the Commissioner of Mental Health in consultation with the Commissioner of Insurance
Rape-related mental or emotional disorders
· Mental or emotional disorders in victims of rape, or assault with intent to commit rape, to the extent the costs of diagnosis and treatment exceed the maximum compensation awarded to victims under the Massachusetts law regarding compensation to victims of violent crime.
There are special provisions for children.
NOTE: Showing the insurance company that the service you want is “medically necessary” is a must, even when the disorder or treatment is covered by the parity law.
3. What special rights do children have?
For children under the 19, the law provides additional safeguards with respect to "non-biologically-based " mental, behavioral, or emotional disorders. These are in addition to the protections for "biologically-based" disorders. Specifically, the law requires health plans to provide coverage to children:
· For non-biologically-based mental, behavioral, or emotional disorders that substantially interfere with or substantially limit functioning and social interactions, where:
· The child’s primary care physician, pediatrician, or a licensed mental health professional has made the referral for diagnosis and treatment of the disorder, and has documented the substantial interference or limitation,
· The substantial interference or limitation is evidenced by conduct, including, but not limited to (1) an inability to attend school, (2) the need for hospitalization, or (3) a pattern of conduct or behavior that poses a serious danger to self or others.
· If a child turns 19 while undergoing treatment, the health plan must continue to provide this coverage until the course of treatment is completed and while the benefits contract covering the adolescent remains in effect. The plan is allowed to charge a premium for these extended benefits, if the child's eligibility for coverage would otherwise end at 19.
4. Does the law cover treatment for alcoholism or other chemical dependency?
Massachusetts law requires that coverage of alcoholism and/or chemical dependency treatment include 30 days inpatient care and $500 worth of outpatient benefits. However, when treatment for these problems occurs in conjunction with treatment for mental disorders, the patient is entitled to broader coverage.
5. What is the minimum coverage for disorders that are not on the list of covered disorders?
For mental disorders that are not on the list of disorders eligible for parity, insurers must provide medically necessary coverage during each 12 month period for a minimum of 60 days inpatient treatment and 24 outpatient visits. Carriers cannot impose other limitations or cost-sharing (such as copayments) on treatment for these mental disorders, unless the same requirements apply to physical conditions.
Medication visits and neuropsychological testing are not subject to these limits, and must be covered on the same terms as medical services.
6. What health plans must comply with the MHPL?
The Mental Health Parity Law applies to all of these health plans:
· Group Insurance Commission ("GIC") plans for government employees and retirees
· Plans issued by Massachusetts-licensed commercial health insurers
· Blue Cross and Blue Shield of Massachusetts plans
· Plans issued by Massachusetts-licensed HMOs
· Small group health plans regulated by Massachusetts insurance authorities
· Non-group health plans
· Student health insurance plans (for higher educational institutions)
The following plans do not have to comply with this law:
· Self-insured employer group health plans.
An employer is self-insured when, instead of paying an insurance company or HMO to cover the health care costs of its employees, the employer itself covers these costs. For more information about your rights in a self-insured plan, call the Department of Labor (regional office) at 617-565-9600 or visit www.dol.gov <http://www.dol.gov/> , or the Attorney General's Insurance Hotline at 1-888-830-6277.
· MassHealth plans
· Medicare plans
7. Does the parity law cover outpatient as well as inpatient services?
Yes. The law states that a full range of inpatient, intermediate, and outpatient services shall be available for the treatment of mental disorders, so that treatment may take place in the least restrictive clinically appropriate setting.
8. What is not covered by the parity law?
· Insurers are not required to cover mental health services for persons incarcerated in jail, prison, Department of Youth Services facilities, or other correctional settings.
· Insurers are not required to pay for those “educational services” that a school must provide as part of its special education program. Note: If there is a medical component to a special education plan, the insurer still should pay for those services which are medically necessary.
· Insurers are not required to cover services provided by the Department of Mental Health.
If you have questions about the Mental Health Parity Law or you need help getting your insurer to pay for mental health services, please contact:
Mental Health Legal Advisors Committee
(617) 338-2345 or (800) 342-9092
Tuesday, July 14, 2009
- NAMI: Empowering our Community by DeMystifying Mental Illness and Treatment TONIGHT at 5 PM at the Boston Public Library (Lauri Martinelli for information)
- Blue Cross Blue Shield is planning a big conference: Improving Access to Children's Behavioral Health Services on Thursday 29 October 2009 at 8 AM at the Landmark Center. (Free but must preregister; contact the Foundation for details)
Monday, July 13, 2009
Sunday, July 12, 2009
Please Join Us:
CMHC Supporters Meeting - Tues, July 14
Please join us for the next Children's Mental Health Campaign supporters meeting on Tuesday, July 14 from 9:30-11AM in the 9th floor conference room at 30 Winter Street.
We have many things to discuss at this meeting, including the final FY 2010 State Budget, progress of the collateral contacts bill, and the implementation of Rosie D. services. If you have any questions or suggestions for agenda items, please contact Matt Noyes at firstname.lastname@example.org or 617-275-2939.
Ask Legislature to Override Rosie D. Veto
Last week, Governor Patrick released his line item vetoes of the Legislature's FY 2010 State Budget.
Among these vetoes was a $2.3 million reduction in funding for implementation of the Children's Behavioral Health Initiative (CBHI), also known as Rosie D. This veto threatens the effectiveness of the community based services that were rolled out on July 1. Please ask your networks to contact their State Representatives and State Senators and ask them to override Governor Patrick's veto of CBHI / Rosie D. funding.
Friday, July 10, 2009
Thursday, July 9, 2009
Dr. Diaz had a lot to say, and at the end of it all, we were speechless. How does anyone do what she had done? She works with adolescents in the City. Initially, I wasn’t sure that this was going to be relevant to this blog, but it turns out to be incredibly relevant; she opened by pointing out that 20% of adolescents have mental health issues, but only 4% of those actually get those needs get addresses. Her program is focused on the uninsured youth, using a positive youth development model rather than a deficit model to assure long term growth. What’s that mean? A lot of programs focus on risk behaviors- she adds the “lens” of the consumer and the strength/asset to more fully understand what is going on with the teenager and to build a relationship that is therapeutic and the key to long term follow-up. She has found that it is really useful to form partnerships with “every organization in New York” that works with children, with has aided them tremendously in their fund-raising.
The core of her program is that they give the patients what they need regardless of ability to pay. She’s been creative at engaging subspecialists as well as getting funding for mental health services, health education services and the other ancillary services that are needed to address all of the needs of adolescents.
Sounds great, no? And yet there is very little evaluation data to support any of these “best practices”- they were recently funded to conduct an external evaluation to look at the impact of all of these services. Overall, her program serves 10,000 youth of color, from all over the metropolitan area, on a budget of $14 million per year, all of which is generated through fundraising.
To me, the most interesting (and relevant) part of her talk was her discussion of the distinction between her funding sources, which are focused on specific parts of the problem of adolescent health, and her care, which she described as wholistic. I am paraphrasing, but I think that she said something like: "I do what they ask of me, then I do what needs to be done" in the care of her high risk adolescent population. That strikes me as an appropriate lesson for the CSAs going forward: the funder (MassHealth) is required by law to cover a number of services; the agencies implementing the program (the CSAs) will need to decide how to use this funding to supply wholistic care.
Nice way to think about the process through which we are currently living.
Wednesday, July 8, 2009
Do you remember April? We had a miserable winter in the Northeast, with much snow, ice and rain, unending coldness and gloom thoughout the land. People kept speaking of this magical time called Spring, when it would all get better. None of us believed it. One day, in middle of April, I spotted a crocus, blooming in a sunny patch of grass. THEN I believed in Spring, and the bloom of flowers and grass and weeds that has accompanied our joyous and wet Spring and early Summer.
Tuesday, July 7, 2009
Veto Explanation: I am reducing this item by an amount not recommended in light of available revenues.
For the purposes of administrative and program expenses associated with the children's behavioral health initiative, in accordance with the settlement agreement in the case of Rosie D. et al. v. Romney, United States District Court for the District of Massachusetts civil action No. 01-30199-MAP, to provide comprehensive, community-based behavioral health services to children suffering from severe emotional disturbances; provided, that the secretary of health and human services shall report quarterly to the house and senate committees on ways and means relative to implementation of the initiative; and provided further, that such quarterly reports shall include, but not be limited to, details of the implementation plan, results of the scheduled plan to date, including a schedule detailing commencement of services and associated costs by service type, and an analysis of compliance with the terms of the settlement agreement to date.and is budgeted at $65,833,963 in the GAA for FY2010. But in the reconciled budget, it was listed at $68,000,000, so that is a $2.1 million (or 3%) cut. (Details of all of the cuts are available here.) So now what?
This veto threatens the effectiveness of the community based services that were rolled out on July 1.Couldn't have said it better myself. Time to man the phones, my friends. Let the legislators know that implementing a new program as you are cutting its budget is a recipe for failure.
Please ask your networks to contact their State Representatives and State Senators and ask them to override Governor Patrick's veto of CBHI / Rosie D. funding.
Monday, July 6, 2009
I hope everyone had a great Fourth of July- I certainly did, what with the fireworks and the ribs and the bicycling and the gorgeous (finally) weather in New England. After re-rereading the Declaration of Independence (see previous post), though, I am reminded that the celebration of our freedom implies a need to engage in the systems of our governance. For those of us interested in providing systems of care for families of children with serious emotional disturbance, there is a brand new opportunity to make a difference in the design of the system: The Systems of Care Committee.
Already I can hear you running for the exits- come back here and listen (or keep reading, which is the same thing). To make this thing work, we need YOU to be on another committee. Implicit in the structure of the CSAs is a feedback mechanism, called the Systems of Care Committee, through which the care coordination process is informed by a group of family members, community members, agency representatives and mental health care providers on what is working and what is not. The groups will meet monthly, and their input into the process must be documented for the remedy to be effective. They ALL will start meeting this month. I know that is another meeting- but is an important one that you should try to build into your schedule. Your mission is to transform it into a transformative event (I didn't say that this is going to be easy!)
I’ve posted the meetings for Central Massachusetts on the “Upcoming Events’ portion of the blog- I’ll try to keep it as current as I can. If other CSAs want to send me their stuff, I will put it up there. But it is incredibly important that as many of us as possible make it to these meetings. They represent our chance to make a difference in this opportunity for real system change.
Remember, you can always find your CSA through the MBHP!
Saturday, July 4, 2009
WHEN in the Course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are Life, Liberty and the pursuit of Happiness. That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form as to them shall seem most likely to effect their Safety and Happiness.
We, therefore, the Representatives of the united States of America, in General Congress Assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by Authority of the good People of these Colonies, solemnly publish and declare, That these United Colonies are, and of Right ought to be Free and Independent States; that they are Absolved from all Allegiance to the British Crown, and that all political connection between them and the State of Great Britain, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. And for the support of this Declaration, with a firm reliance on the Protection of Divine Providence, we mutually pledge to each other our Lives, our Fortunes and our sacred Honor.
Happy 233rd birthday, everybody!