I want to show today why policies like Trans Pacific Trade Pact and the dismantling of Federal Constitutional protections is happening. Republican voters may think they support some of these policies but at the same time they are shouting against them not understanding they are being duped by Bush neo-cons just as the Democratic voters are being duped by Clinton neo-liberals----both making the GLOBAL CORPORATE TRIBUNAL PARTY. The reason you know Obama and Congressional neo-liberals are working to end SS and Medicare and installing Trans Pacific Trade Pact just as hard as Republicans can be seen below.
FDR pushed for this Act after the Great Depression as a way to install the New Deal----holding banks and the rich accountable for imploding the economy with fraud and profiteering as they are doing now. You see this Act allows Executive Order to allow reorganization plans to implement policies a President wants to install. Below you see what the Clinton Administration installed during his terms----NO REPUBLICAN NEEDED BECAUSE CLINTON IS A WALL STREET GLOBAL CORPORATE NEO-LIBERAL---NOT A DEMOCRAT. Clinton used this Executive Order Authority to define Federalism-----as limited to international affairs and not to interfere with states rights to a broad degree. Clinton did this to build the structure of the Federal government working for the interests of this Global Corporate Tribunal while states handled the business of domestic issues---ergo, the dismantling of all Federal protections for civil rights, liberties, labor and justice law. It also set the stage for moving Federal programs like Medicare and Medicaid, Disability, and Education to the states. Now, this is a Republican dream come true---they have wanted for decades to get rid of FDR's and LBJ's progressive hold on Federal policy. But what Republican voters don't understand that this is the very policy that allows the US be tied to these global governing structures taking away our national sovereignty and US Constitutional rights. We see all around the nation where Clinton neo-liberals and Bush neo-cons have installed their pols to control state and local government pushing conservative Republicans and Progressive labor and justice completely out of the politics of the state. THIS IS WHAT HAPPENED IN MARYLAND.
You may find all this boring----but it is the key to knowing that Affordable Care Act and myRA are about ending Federal programs and sending them to the states to be administered as block grants....meaning institutions like Johns Hopkins controls all revenue dispersal and public policy without Federal oversight. WE ALL KNOW HOW THAT TURNED OUT!
Under authority of the Reorganization Act of 1939 (5 U.S.C. 133-133r, 133t note), various agencies were transferred to the Executive Office of the President by the President's Reorganization Plans I and II of 1939 (5 U.S.C. app.), effective July 1, 1939. Executive Order 8248 of September 8, 1939, established the divisions of the Executive Office and defined their functions. Subsequently, Presidents have used Executive orders, reorganization plans, and legislative initiatives to reorganize the Executive Office to make its composition compatible with the goals of their administrations.
This agency has published 4,894 documents since 1994.
Here you see Burwell including the definition of Federalism embraced by Obama as well since he is a Clinton neo-liberal----into the Medicare and Medicaid Services procedure. This Executive Order defining Federalism is what moves all policy towards global corporate tribunal rule on the Federal level and all Federal involvement of domestic policy to the state...
THESE NEO-CONS AND NEO-LIBERALS ARE LAUGHING ALL THE WAY TO THE BANK AS THEY PRETEND TO BE PROTECTING ALL THESE FEDERAL PROGRAMS AS THEY ALLOW THE MANDATE TO DISMANTLE THEM.
Make no mistake---both Republican and Democratic voters are losing their rights as citizens to this Executive Order......why don't you know this? Because Reagan Clinton neo-liberal education reforms in the 1990s defunded and dismantled public education and students have learned less and less about civics and history these few decades and YOUR LABOR AND JUSTICE LEADERS ARE NOT EDUCATING ON PUBLIC POLICY---THEY ARE SIMPLY SHOUTING SLOGANS!
Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct effects on states, preempts state law, or otherwise has federalism implications. The BHP is entirely optional for states, and if implemented in a state, provides access to a pool of funding that would not otherwise be available to the state.
Dated: February 4, 2015.
Administrator, Centers for Medicare & Medicaid Services.
Dated: February 13, 2015.
Sylvia M. Burwell,
Secretary, Department of Health and Human Services.
Neo-liberal President Bill Clinton
Executive Order 13132 of August 4, 1999
Section 1. Definitions. For purposes of this order:
(a) ‘‘Policies that have federalism implications’’ refers to regulations, legislative
comments or proposed legislation, and other policy statements or
actions that have substantial direct effects on the States, on the relationship
between the national government and the States, or on the distribution
of power and responsibilities among the various levels of government.
Using this information and continuing on the discussion of SS and Medicare------we can understand more the goals of health policy!
Below you see the kinds of decisions being made for Medicare and Medicaid access to health care made by health institutions working for profit, not health results. This is absolutely outrageous as the scientific article shows PET scans to be a definite benefit to diagnosis and treatment of neurological disease----but look closely-----IT IS AN EXPENSIVE TREATMENT----WITH HEATLH CARE AS PROFIT THE COSTS WILL NEVER COME DOWN AS THEY USED TO ----AND THAT IS TO WHAT THIS POLICY IS DIRECTED.
This policy takes away basic diagnostic procedures from Medicare and Medicaid patients. If you want these procedures----you pay for it.
THESE ARE THE KINDS OF HEALTH DECISIONS MADE BY PANELS OF PEOPLE ONLY CONSIDERING MAXIMIZATION OF PROFITS BY THE HEALTH INDUSTRY.
'J Neurol. 2012 Sep;259(9):1769-80.
Positron emission tomography imaging in neurological disorders.
Politis M1, Piccini P.Author information
Positron emission tomography (PET) is a powerful tool for in vivo imaging investigations of human brain function. It provides non-invasive quantification of brain metabolism, receptor binding of various neurotransmitter systems, and alterations in regional blood flow. The use of PET in a clinical setting is still limited due to the high costs of cyclotrons and radiochemical laboratories. However, once these limitations can be bypassed, PET could aid clinical practice by providing a useful imaging technique for the diagnosis, the planning of treatment, and the prediction outcome in various neurological diseases.This review aims to explain the PET imaging technique and its applications in neurological disorders such as Parkinson’s disease, Huntington’s disease, multiple sclerosis, and dementias'.
Decision Memo for Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease (CAG-00431N) Decision Summary A. The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is insufficient to conclude that the use of positron emission tomography (PET) amyloid-beta (Aβ) imaging is reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member for Medicare beneficiaries with dementia or neurodegenerative disease, and thus PET Aβ imaging is not covered under §1862(a)(1)(A) of the Social Security Act (“the Act”).
B. However, there is sufficient evidence that the use of PET Aβ imaging is promising in two scenarios: (1) to exclude Alzheimer’s disease (AD) in narrowly defined and clinically difficult differential diagnoses, such as AD versus frontotemporal dementia (FTD); and (2) to enrich clinical trials seeking better treatments or prevention strategies for AD, by allowing for selection of patients on the basis of biological as well as clinical and epidemiological factors.
Therefore, we will cover one PET Aβ scan per patient through coverage with evidence development (CED), under §1862(a)(1)(E) of the Act, in clinical studies that meet the criteria in each of the paragraphs below.
- For patients covered by health insurance, typical out-of-pocket costs would consist of coinsurance of 10%-50%. For example, at Dartmouth-Hitchcock Medical Center in New Hampshire, a patient with Medicare and no supplemental insurance could pay $1,500 for a whole-body scan. A PET scan is typically covered by health insurance, with some exceptions. For example, Aetna considers PET scans medically necessary for diagnosis and management of many cardiac conditions and many types of cancer; however, for certain conditions, such as cancers of the central nervous system, they are considered investigational and not covered.
- For patients not covered by health insurance, a PET scan typically costs an average of about $4,900 for a PET scan of the whole body to $6,700 for the brain and $6,800 for the heart, according to NewChoiceHealth.com
Just so you don't get the idea that these regulations for what kind of health care public health plans like Medicare and Medicaid will have access to----below you see the announcement for the MEDCAC Panel making these decisions. Corporate appointments rule!
Health Industry Washington Watch by ReedSmith
Posted on September 5, 2012 by Debra A. McCurdy
CMS Seeks Nominees for MedCAC, HOP Panels
CMS is soliciting nominations for a total of 42 voting and nonvoting members of the Medicare Evidence Development & Coverage Advisory Committee (MedCAC), which advises CMS on the adequacy of scientific evidence available to CMS for Medicare “reasonable and necessary” determinations. Nominations must be received by September 24, 2012. CMS also is seeking nominations for two new members to the Advisory Panel on Hospital Outpatient Payment (HOP), which advises the agency on the clinical integrity of the Ambulatory Payment Classification (APC) groups and their associated weights, and supervision of hospital outpatient services. Nominations are due by October 23, 2012.
Below you see how all of these decisions work.......Molecular Pathology Testing is the newest medical procedure bringing tons of profit to the corporations patenting these procedures. It is the kind of medical research and patenting Johns Hopkins and its corporate research facility are making. So, to keep new technology profitable---you assign it to private insurance plans paying the most----not to Medicare and Medicaid patients. Keep in mind all this technology was discovered using Federal NIH/NCI grants----we paid for these discoveries. The latest testing procedures are the least invasive.
March 24, 2015 MEDCAC Questions
Molecular Pathology Testing to Estimate Prognosis in Cancer On March 24, 2015, the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) will consider evidence about molecular pathology tests that estimate prognosis for Medicare beneficiaries with several frequently encountered types of cancer:
Outcomes of interest for CMS reflect beneficiaries’ benefits or harms due to anti-cancer treatment decisions based on test results. Outcomes of interest include (among others) mortality, avoidance of harms of inappropriate anti-cancer treatments, and quality of life.
As you see, these Molecular Tests are all of what is coming out in new research and the FDA is approving them right and left with little clinical trial study. But look! Medicaid will allow access to these tests if it is done under the category of clinical study------OH, YOU GET ACCESS TO BASIC HEALTH PROCEDURES AS A RESEARCH STUDY PATIENT.
This is nothing new for Baltimore citizens wanting health care-----Johns Hopkins has been doing this for decades----now they are mainstreaming. Clinical trials have historically had an ethics clause that people participating are not allowed to have this as their only access to health care!
FDA Approved/Cleared Molecular Diagnostic Tests FDA maintains on its website lists of nucleic acid-based tests and companion diagnostic tests. Links to those web pages are below.
Nucleic Acid Based Tests
Companion Diagnostic Devices
If you find that the URLs have changed, or the links are broken, please notify AMP and FDA.
Just one more technical post on Affordable Care Act reforms----we see funds directed to preventative programs for at-risk families and children under CHIP. Below you see what I think is the most obtrusive health policy aimed at at-risk families ever. It creates a system designed to tie health care to what is mental health screening targeting people arbitrarily deemed pre-disposed. Now, substance abuse is highest in wealthy families and their children----do you think these invasive mental health policies are going to monitor them for what will become sociopathic behaviors regarding PROFIT AT ALL COST? Baltimore has already developed mental health programs that have citizens targeted with home visits by police and social workers because they have intel that claims a person may be a problem.
FOLKS----IF YOU ARE NOT SEEING FASCISM----YOU ARE NOT LOOKING CLOSE ENOUGH.
This is just a segment of this policy----please take time to read this.
Substance abuse is soaring in the US and we know it is directly tied to moving the US to third world status---poverty deepens-----cultural norms are lifting political correctness so partying and associated behaviors are mainstreaming. We had the best outcomes as regards substance abuse with children for decades under War on Poverty health policy. The very Clinton neo-liberals who defunded and dismantled these programs are now interested in helping these groups? REALLY??? Funding for mental health has never been lower since Affordable Care Act reform but they seem to find funds to install what is the most aggressive social monitoring program written broadly enough to capture most people.
BIMAS™Behavior Intervention Monitoring Assessment System
James L. McDougal, Psy.D.
Achilles N. Bardos, Ph.D.
Scott T. Meier, Ph.D.
The Behavior Intervention Monitoring Assessment System (BIMAS™) is a measure of social, emotional and behavioral functioning in children and adolescents ages 5 to 18 years. The BIMAS Standard includes 34 change-sensitive items that are used for universal screening and for assessing response to intervention. The BIMAS Standard items were developed based on years of research and a scientific model for selecting items that are sensitive to change called Intervention Item Selection Rules (IISRs; Meier, 1997, 1998, 2000, 2004). The BIMAS is the only commercially available measure comprised of items with demonstrated change sensitivity based on the IISRs model.
The BIMAS Flex is an additional pool of behavioral items that provide information on specific intervention targets or goals within the five areas assessed by the Standard Form. The BIMAS offers an online Data Management System with dynamic analysis, graphing and reporting options. This allows assessors to manipulate data in a variety of ways in real time to assist in evidence-based decision-making within an Response to Intervention (RtI) framework.
The BIMAS is a brief, repeatable multi-informant measure that is useful for behavioral universal screening, progress monitoring, outcome assessment, and program evaluation within the RtI framework. BIMAS provides evidence-based data and outcome reports on individuals and groups.
There are three main objectives:
- Universal Screening – By comparing each student’s scores on the BIMAS to a normative group, the BIMAS Standard can be employed as a brief screening device to detect students in need of further assessment and to identify their respective areas of need.
- Student Monitoring – To provide feedback about the progress of the individual student or groups in intervention programs.
- Program Evaluation – To assess changes in behavioral concerns and adaptive skills in a group of students receiving psychosocial interventions (e.g. school-based mental health and special education programs provided on an individual or group basis).
Scales & Forms
The BIMAS is comprised of standard scales (BIMAS Standard) which can be used as a screening device, to collect baseline data at the beginning of intervention, and for periodical progress monitoring. The BIMAS also is comprised of a pool of items that can be used to develop customized behavioral intervention goals for frequent monitoring (BIMAS Flex).
- BIMAS Standard
- Can be used as a brief screener, a tool for treatment monitoring, or for program evaluation (or combination)
- Consists of 34 change-sensitive items on 5 subscales with forms for parents and teachers (ages 5-18 years), and youth (ages 12-18 years) to complete with both standardized scale-level and item-level norms established from a U.S. national sample closely matching the census
- Also available is a non-norm-referenced clinician form for rating youth 5 to 18 years
- BIMAS Flex
- Distinct, more specific behavioral items (10-30) for each of the 34 BIMAS Standard form items on the 5 scales
- Both positively and negatively worded items to select from
- Assessors can customize treatment goals by selecting behaviors of concern and create three-to-five-item mini-assessments for
- frequent progress monitoring to assess change in behavioral concern or adaptive skills
- Assessors can make notes to describe specific behaviors, response to intervention, or to add other information about the student
- Behavioral Concern Scales - Identify Risks
- Conduct - anger management, bullying behaviors, substance abuse, deviance
- Negative Affect - anxiety, depression
- Cognitive/Attention - attention, focus, organization, planning, memory, planning, organization
- Adaptive Scales - Identify Strengths and Areas of Improvement
- Social - social functioning, friendship maintenance, communication
- Academic Functioning - academic performance, attendance, ability to follow directions
Joint CMCS and SAMHSA Informational Bulletin
DATE: January 26, 2015 FROM: Vikki Wachino Acting Director
Center for Medicaid and CHIP Services
Pamela S. Hyde, J.D.
Substance Abuse and Mental Health Services Administration
SUBJECT: Coverage of Behavioral Health Services for Youth with Substance Use
This informational bulletin, based on evidence from scientific research and the results of a Substance Abuse and Mental Health Services Administration (SAMHSA)-supported technical expert panel consensus process, is intended to assist states to design a benefit that will meet the needs of youth with substance use disorders (SUD) and their families and help states comply with their obligations under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements. The services described in this document are designed to enable youth to address their substance use disorders, to receive treatment and continuing care and to participate in recovery services and supports. This bulletin also identifies resources that are available to states to facilitate their work in designing and implementing a benefit package for these youth and their families.
“Brain development during adolescence and emerging adulthood is one element that makes youth a period of particularly high vulnerability to SUDs.” Adolescence is the time most of the people who become addicted develop their addiction More than 90 percent of adults with SUDs started using before age 18; half of those began before age 15. Individuals who begin drinking before age 14 are seven times more likely to develop alcohol dependence than those who begin
Substance Abuse and Mental Health Services Administration. (2013). What does the research tell us about good and modern treatment and recovery services for youth with substance use disorders? Report of the SAMHSA Technical Expert Panel, December 5–6, 2011. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. 07/01/13 Draft.
SAMHSA, What does the research tell us, p. 44
CMCS Informational Bulletin – Page 2
drinking at age 21.
The earlier a person begins using, the more likely the substance use disorder will develop and continue into adulthood.
About 6.1 percent of adolescents between the ages of 12 and 17 were classified as substance abusive or dependent (alcohol or illicit drugs) in 2012. The rate of substance abuse or dependence among young adults aged 18–25 was 18.9 percent in 2012. In addition, abuse of prescription drugs is high among youth aged 12 to 17. In 2010, 3.0 percent of youth reported past-month nonmedical use of prescription medications. Youth who abuse prescription medications are also more likely to report use of other drugs. Multiple studies have revealed associations between prescription drug abuse and higher rates of cigarette smoking; heavy episodic drinking; and marijuana, cocaine, and other illicit drug use among adolescents, young adults, and college students.
Youth with SUDs also have high rates of co-occurring mental health disorders. SUDs increases the risk for mental health disorders and vice versa, and the majority of youth with SUDs have a co-occurring mental health disorder. In a study of data from the Global Appraisal of Individual Needs (GAIN), approximately 90 percent of substance-dependent adolescents under age 15 had at least one mental health problem in the past year. Furthermore, approximately 88 percent of the substance-dependent adolescents between ages 15 and 17 and 84 percent of the young adults aged 18–25 had co-occurring mental health issues.
Youth with SUDs also face considerable academic, health-related, relational, and legal challenges. These issues also bring costs and consequences to families, communities, and society.
Technical Expert Panel
Unlike other populations with behavioral health conditions, there is a lack of guidance regarding the treatment, continuing care and recovery supports needed for youth with SUDs or youth with SUDs and co-occurring mental health disorders. Because the growing body of research on youth with SUDs had not been systematically collated, reviewed and translated into practice guidelines, SAMHSA convened a technical expert panel comprised of nationally-recognized researchers to review the existing literature and utilize a structured process to identify what the research tells us about treatment and recovery services for youth with SUDs.
In discussing the optimal benefit design to provide effective treatment for youth with SUDs, technical expert panel members affirmed that practice must be rooted in the emerging neuroscience research in conjunction with the ever-growing psychosocial treatment effectiveness research. They stressed that treatment approaches must be developmentally appropriate and incorporate an understanding of the importance of family.
Selected Components of a Continuum of Services and Supports
The consensus findings from the technical expert panel suggest a continuum of treatment and recovery services and supports for youth with SUDs. The following section identifies selected components of a continuum of services to identify, treat, maintain gains and support recovery for youth with substance use or substance use and co-occurring mental health disorders.
There is evidence that “the short- and long-term impact of substance use on the brain suggests priority must be given to the screening and early identification of SUDs in youth.” Because of the high rate of co-occurring disorders, every youth should be screened for both substance use and mental health disorders wherever they present. Youth with positive screens must be assessed with an evidence-based, comprehensive psychosocial assessment instrument that assists in identifying the level of severity of substance use disorder and/or substance use and mental health disorder and suggests the appropriate level of care.
As this article shows Maryland has historically been one of the worst in the nation to fund mental health and the funds that do come go to PHARMA distribution with no oversight. Baltimore's mental health network is the worst. Yet, Baltimore pols introduced in the Maryland Assembly legislation that creates just what this corporate program creates-----and the Federal Medicaid funding seeks to build----this behavior monitoring system. Now, there is no bigger BIG BROTHER than Hopkins----it is ground zero for spying and surveillance corporations. It appears to me that these mental health reforms are more about an extension of this BIG BROTHER system and less about concern for the citizens of Baltimore. We are watching as a global corporation comes in and sets up a program with broad definitions of what an at-risk population looks like. Given Baltimore's massive corruption and corporate fraud----we would like them to start with the sociopathy at the upper end of the income ladder!
BIMAS™Behavior Intervention Monitoring Assessment System
You can see this article points to a chronic disregard to mental health care----so when global corporate pols fund a mental health project ----we look to goals more in line with the big picture in Maryland---
Mental health advocates outraged by lack of state funding for psychiatric care, cuts in governor’s budget
By Ilana Kowarski Ilana@MarylandReporter.com
Lack of psychiatric hospital beds is one of the problems identified by mental health advocates (Photo by StudioTempura/Flickr)
There has been a great deal of partisan bickering in the debate over gun control. But the one thing Democrats and Republicans tend to agree on is the need to improve the mental health system, so that potential mass shooters are treated before their violent fantasies become a reality.
Maryland’s new gun control laws prohibit gun purchases by those who have been involuntarily committed by a judge or those who were voluntarily committed for over 30 days.
Mentally ill Marylanders have cried foul, saying that they have become the scapegoat for a national tragedy. They say that they are not getting the help they need from the state, and that they have been neglected by politicians who claim to care about their well-being.
Mental health providers concur, arguing that the state’s psychiatric services are woefully underfunded and that the General Assembly has done little to address this problem. They were particularly shocked that the governor revoked $7.2 million of funding for mental health in his supplemental budget this week.
“It’s like the mental health part of the state budget is the red-headed stepchild. We get the scraps that fall to the floor, if there are any,” said Denise Camp, an outreach coordinator for On Our Own of Maryland who became an advocate for the mentally ill after a lifetime of struggling with depression and suicidal compulsions. “I’m not a psychiatrist, but psychiatrists have helped me, and when they get shafted, I get upset.”
Proposals for more funding unlikely to pass
Sen. Richard Madaleno, D-Montgomery, and Del. Sandy Rosenberg, D-Baltimore City, each proposed bills that would provide $40 million of additional mental health funding, but those proposals have gotten no traction in either house.
The Department of Budget and Management opposes this legislation, arguing that an overhaul of the mental health system is too expensive for the state to pursue at this time. Kim Burton, a director at the Mental Health Association, said that the needs of Maryland’s mentally ill are too great to ignore.
“There really isn’t a question about what is needed to make our mental health system more proactive, effective, comprehensive and just,” Burton wrote. “What we don’t have – and couldn’t get this session – is the commitment of our state’s leaders to the high cost of implementing the recommendations.”
Burton also objected to legislators’ rhetoric about the mentally ill during the gun debate. She argued that this rhetoric would increase the stigma of psychiatric disorders and make it harder for the mentally ill to acknowledge their disease and seek treatment.
“Though there is no data to support that people with mental illness are more dangerous than the general public, our legislature has moved forward with highly discriminatory and misguided amendments to the gun legislation which unfairly targets individuals with mental illness even if they pose no threat to public safety,” she wrote.
Surprise cut in governor’s supplemental budget despite rise in patients
Resentment among Maryland mental health advocates has been festering for years as the state has progressively reduced the number of subsidized psychiatric care beds and repeatedly dipped into the Mental Hygiene Administration’s coffers to compensate for shortfalls in the general fund.
Psychiatrists and their patients are now protesting, and some claim that they have reached their breaking point, since Gov. Martin O’Malley revoked the Mental Hygiene Administration’s $7.2 million surplus for this fiscal year.
The surplus was in the state’s Medicaid payments for mental health, but advocates said they could have used it to pay for community psychiatric clinics.
O’Malley’s decision was announced in his supplemental budget this week, a move that shocked mental health advocates.
“Nobody in the advocacy community had any hint that this was coming,” said Herb Cromwell, the executive director of the Community Behavioral Health Association.
The governor did deliver a $5 million increase in the 2014 appropriation for mental health, but these increases were outweighed by budget cuts in the current fiscal year.
Budget surpluses revert to general fund
Karen Black, spokesman for the Department of Health and Mental Hygiene, defended the governor’s financial choices, explaining that the state routinely returned the agency’s budget surpluses to the general fund.
The surplus was a result of the agency overestimating the cost of providing services to Medicaid recipients. Since the estimate was high, she stated, the surplus was returned, but if it had been low, then the governor would have appropriated more money to meet the need.
“The governor included an additional investment of $5 million for mental health services in his supplemental budget, above what is required to be provided to Medicaid recipients,” Black stated. “These dollars will fund crisis services, mental health first aid training, and creating a center of excellence for serious mental illness.”
Maryland’s mental health providers say that they are grateful for the additional state funding in 2014, but that the governor’s cut to the Mental Hygiene Administration’s 2013 budget comes at a particularly bad time, since they have experienced a 50% increase in referrals during the Great Recession.
Studies consistently show that depression and suicide rates spike during times of economic hardship. A 2011 survey from the National Alliance for Mental Illness revealed that 13% of America’s unemployed have contemplated suicide.
Mental health providers object
When mental health providers realized that they would not be getting the money they were counting on, they sent letters of protest to O’Malley.
In his letter, Cromwell stated that the funds would have gone directly to outpatient mental health clinics that provide treatment and medication for 140,000 children and adults using the public mental health system.
“To have it taken away at the last minute is stunning,” Cromwell stated. “Community providers continue to do everything they are asked to do and more, including serving 50,000 additional customers in the last six years because of increased demand brought on by the Great Recession. They have done so at a lower per capita cost than was the case in 2004. And this is the thanks they get.”
Some of the Mental Hygiene Administration’s budget surplus had been allocated to health care providers by the General Assembly before the governor returned the surplus to the general fund.
$2.1 million was earmarked to raise psychiatrists pay. They have consistently received lower reimbursement rates than other physicians in the state, despite a 2010 parity law mandating that they receive comparable compensation.
The General Assembly had allowed for the other $5.1 million to be used to fund community psychiatric clinics, but those plans are nixed by the governor’s supplemental budget.
Hospitals lack psychiatric beds
Dr. Steve Daviss (Baltimore-Washington Medical Center)
Those on the front lines of the mental health care system say that state funding is inadequate. Dr. Steve Daviss, chairman of psychiatry at the Baltimore-Washington Medical Center, said that his hospital does not have enough mental health care beds and that this is partly because the state provides less money for psychiatric services than for other kinds of medical care.
The General Assembly has reduced funding for inpatient psychiatric care beds for several years, and recently eliminated all remaining funding for psychiatric care beds in private hospitals, striking $1.25 million from the 2014 budget.
Legislative analyst Simon Powell argued that this cost-saving measure was appropriate. Hospitals will eventually be reimbursed for uncompensated psychiatric care through higher rates enacted by the state and paid by insured health consumers, making up for those who are unable to pay for their own psychiatric treatment, Powell said.
However, he argued that psychiatric reimbursement rates should be higher than they are now, since there is substantial unmet need in the state’s mental health care sector and hospitals have little financial incentive to provide mental health services.
Daviss said that there is a severe, statewide shortage in the number of inpatient psychiatric beds. The result, he says, is that psychiatric patients wait for hours — sometimes days — for inpatient care after arriving in emergency rooms, even when they are in desperate need of medical attention.
“There are times when every single psychiatric bed in the state is full,” he said. “It’s like going to a popular restaurant, seeing long lines, and waiting for someone to leave so you can move in. If there’s no beds, there’s no beds, whether you have insurance or not.”
Doctor: delayed treatment puts patients on verge of suicide
Daviss said that psychiatric patients also had difficulty getting outpatient appointments and other support services. He attributed this in part to a lack of state financing and in part to a lack of regulation ensuring that insurance providers gave clients a sufficient number of in-network psychiatrists.
He also argued that the disparity between the state’s psychiatric reimbursement rates and other medical care rates made hospitals less willing to provide mental health care, since they are unlikely to make a profit.
Due to these factors, Daviss believes that the state’s mentally ill population often stays in the shadows until they can no longer cope with their disease, and he says that he has witnessed the cost of delayed psychiatric treatment.
“People go a lot longer before getting treatment – they go until they just can’t function anymore or until they are forced to get help,” he said. “Many of my patients are people at the end of their rope, and they are ready to kill themselves. They say, ‘I can’t get the help I need.’”
Daviss said that he knows that quality support services can make a difference because of one of his patients, who attempted suicide twice last year but began the road to recovery after the hospital connected her with outpatient counseling. “Before she did not have hope, and now she does,” Daviss said.