2013 Behavioral Health Public Policy Agenda

534 S. Kansas Ave, Suite 330, Topeka, Kansas 66603

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Mental Health Services

Support Governor’s Mental Health Initiative for At-Risk Individuals. In the Governor’s budget recommendations for FY 2014, he proposes to take $5 million from the Mental Health Reform grants as well as $5 million from the Family Centered System of Care program (currently funded with tobacco dollars through the Children’s Initiative Fund) to create a $10 million initiative that is focused on uninsured/underinsured mentally ill individuals who are most at-risk of admission or re-admission to a State psychiatric hospital; incarceration; contact with law enforcement; and out-of-home placement. This is not new money. Rather, it is refocusing a portion of our existing resources. The Governor’s budget recommendations do stabilize funding for the Community Mental Health Center (CMHC) system.

Restore Cuts to Mental Health Reform Funding. Mental Health Reform dollars allow the CMHCs to serve the uninsured and underinsured who do not qualify for Medicaid and do not have resources to pay for their mental health treatment. It is this funding which essentially ensures every Kansan has universal access to mental health treatment. The CMHCs have a State mandate to serve everyone regardless of their ability to pay. If those living with mental illness do not receive timely treatment, they could easily end up being admitted into a State psychiatric hospital – the most costly level of care for the State. Mental Health Reform in 1990 allowed the State to reduce its reliance on State psychiatric inpatient resources by shifting funding from State hospitals to community based programs. Since FY 2008, this funding stream has been reduced by almost 50%, though the demand for services from the uninsured and underinsured continues to increase.

Address Critical Needs in Psychiatric Inpatient Resources. Reductions in State psychiatric inpatient budgets, coupled with funding reductions in Mental Health Reform dollars, have resulted in our system reaching a breaking point. The State hospitals are the inpatient safety net for individuals with severe mental illness in Kansas. All hospitals have seen a continually growing number of patients that present for treatment. Seventy (70) percent of those admitted to State hospitals do not have Medicaid as a payor source. What is needed? The 30 bed unit at OSH needs to come online. That comes with a price tag of $3.4 million SGF. Funding to establish local public/private partnerships for psychiatric inpatient hospitals beds across Kansas to alleviate demand on our State hospital beds or the creation of regional Crisis Stabilization Units.

Create a KanCare Oversight Committee in the Kansas Legislature. The new Kansas Medicaid plan titled KanCare went into effect on January 1, 2013. This plan impacts all Medicaid consumers by contracting out all services under Medicaid to three Managed Care Companies. Given that more than 300,000 Kansans are eligible for and served by Medicaid; that this is a sea change for providers and consumers alike; and that $3 billion is spent annually on Medicaid in Kansas - it is critical that the Kansas Legislature have oversight of this program.

Protect Access to Medically Necessary Mental Health Prescription Drugs. The Association opposes policies that restrict access to medically necessary medications. Preferred drug lists (PDLs) with prior authorization requirements, restrictive formularies, fail first requirements, monthly prescription limits, and tiered co-payment structures–all fail to achieve their intended purposes of reducing overall healthcare costs. They do, however, prolong human suffering and reduce the potential for an individual with mental illness to achieve full recovery. Such policies wouldthreaten the safety, health, and ultimately jeopardize the recovery process for persons with a mental illness. Children, too, would be negatively impacted by implementing these policies since many of the newer drugs (called atypical antipsychotics) are more advanced and effective than the previous generations and may work very well to help a child stabilize and function well.

Include Community Mental Health Centers in definition of Charitable Health Care Providers. The Association supports health care that is provided for Kansas residents who are indigent or uninsured. Both the Community Health Clinics (CHCs) and CMHCs that serve Kansas counties are required by law to serve all who present, regardless of their ability to pay. Thus, both CHCs and CMHCs provide charitable care as defined in K.S.A. 75-6102 (e) (3). The Department of Health and Environment (KDHE) houses the Medicaid agency for the state. Charitable health care providers must enter into an understanding with the Secretary of KDHE to provide charitable care to Kansans, in order to be deemed Charitable Health Care Providers in Kansas. To list the two types of charitable health care providers in our state in statute makes it clear in case there are any disputes or questions around the issue.

Support Policy Change to Suspend rather than Terminate Medicaid Eligibility upon Incarceration. Support the government’s primary responsibility for the provision of health and mental health care to the State’s most vulnerable citizens—those with disabilities, both physical and psychological. This includes suspension of, NOT termination of, Medicaid eligibility when an individual is incarcerated in a county facility or state prison. Upon release, the ex-offenders’ eligibility should immediately be reinstated to ensure those individuals with mental illness or substance abuse are able to immediately access care, treatment and needed medications upon release. At this time, Kansas law does not allow for suspension of Medicaid eligibility to be reinstated upon release from prison.

Expansion of Medicaid is Good for Kansans with Mental Illness. The Affordable Care Act (ACA) includes a significant expansion of Medicaid that will positively impact Kansans with mental illness. Under the law, all persons who meet the new national income limit of 133% of the federal poverty level (FPL) ($29,326 annual income for a family of four in 2009) based on modified adjusted gross income will be eligible for Medicaid In Kansas, more than half of those who present for treatment at CMHCs have no insurance. Without treatment, these individuals will decompensate, and may end up in jails, emergency rooms or state hospitals—all of which are much more expensive than community based services. Expansion of Medicaid will provide coverage for those who have a mental illness so they can access needed mental health treatment in their communities. If Kansas expands Medicaid up to 133% FPL, the federal government will provide 100% funding for all new eligibles from 2014-2016; 95% in 2017; 94% in 2018; 93% in 2019; and 90% in 2020 and after. Kansas would be doing a disservice to those Kansans who have a serious mental illness by not expanding Medicaid while this opportunity is in play. States must put this expansion into affect by January 1, 2014.

Substance Abuse Services

Support Current Funding for Substance Abuse Treatment and Prevention. Since 2008, $10 million in cuts have impacted the substance abuse treatment and prevention system. Substantial funding commitments by the Legislature must be sustained and not reduced or client care and treatment will be negatively impacted. According to SAMHSA, for every $100,000 spent on treatment, there is a cost savings estimated at $487,000.

Support KDADS Strategic Plan for the Problem Gambling and Other Addictions Fund. The legislative intent behind the PGAOF was to create not only funding for problem gambling services, but also to enhance revenue for substance abuse treatment and prevention. We believe a sizable portion of the PGAOF should be dedicated to fully funding the State’s addiction treatment services. These funds have not kept pace with provider costs or demands for services.

Oppose Any Changes to the Addiction Counselor Licensure Act. We oppose any changes to substance use disorder regulations and statutes that negatively impact addiction counselor licensure. Legislation passed in 2010 and 2011 placed addiction counselors under BSRB authority. The addictions counselors system has gone through profound changes. The Legislature should resist new efforts to further modify this system in support of negotiated agreements among all interested parties.

Support Public Safety Components of Community-Based Treatment. Alternative Sentencing for Substance Abuse Treatment Law (SB 123) and continue DUI treatment alternatives are wise investments to avoid greater costs.

Support and Expand the Medication Program fund to Include Anti-Craving and Opioid Replacement Therapies. An estimated 65% of individuals in U.S. prisons or jails have a substance use disorder, and a substantial number are addicted to opioids. Scientific research has firmly established that treatment of opiate dependence with medications reduces addiction and related criminal activity more effectively and at far less cost than incarceration. Medication assisted therapies such as methadone or buprenorphine, to normalize brain chemistry, block the euphoric effects of opioids, relive physiological cravings, and normalize body functions without the negative effects of short-acting drugs of abuse.

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