By Dave Ranney
TOPEKA – State officials say they’ve reached an agreement with mental health providers for regulating Medicaid patients’ access to antipsychotic medications. “We are all working toward a common goal: Providing safe access to mental health drugs for those who need them,” Kansas Department of Health and Environment Secretary Susan Mosier said in a prepared statement Wednesday.
Kansas Department for Aging and Disability Services Secretary Kari Bruffett and Kyle Kessler, executive director for the Association of Community Mental Health Centers of Kansas, expressed similar support for the measure.
“I think this is a positive step forward in improving and expanding upon sound mental health drug prescribing practices,” Kessler said.
Under the agreement, a nine-member panel of hands-on mental health practitioners – psychiatrists and pharmacists, primarily — will be charged with developing evidence-based guidelines for prescribing antipsychotic medications. The advisory committee will spell out the circumstances under which KDHE, the state’s Medicaid agency, and the Drug Utilization Review Board can intervene in prescribing decisions.
Currently, Kansas law guarantees Medicaid patients ready access to whatever mental health drugs their physicians or psychiatrists see fit to prescribe.
Kessler and several mental health center directors last month testified against a KDHE-introduced measure, Senate Bill 123, that would have repealed the guarantee. Opponents of the bill said delaying or depriving patients’ access to medications could put them and others in their communities at risk.
KDHE and KDADS insisted the repeal would reduce the risk to patients, children in particular. They cited reports that documented instances of providers prescribing adult antipsychotics to children. The agencies said tighter regulation of behavioral health drugs could also save KanCare – the state’s Medicaid program — more than $7 million.
The Senate Public Health and Welfare Committee endorsed the bill but it stalled in the full Senate. The committee revived the bill on Wednesday using a complicated set of procedural maneuvers. The compromise language and parts of the original bill are now folded into a new bill, – Senate Substitute for House Bill 2149.
The full Senate is expected to vote on the compromise proposal next week, after which, assuming it passes, it will be sent to the House. Compromise a surprise to some The Wednesday vote caught many mental health advocates off-guard. “We were surprised that statutory language got dropped into committee yesterday,” said Amy Campbell, executive director for the Kansas Mental Health Coalition.
Even so, Campbell said, the coalition is cautiously supportive of the compromise. “We feel like what’s being proposed is an improvement over the original (SB) 123,” Campbell said. “But we continue to communicate with the agencies (KDADS and KDHE) to get some questions answered.
There are some things we’d like to see formalized.” Under the compromise, patients whose drug regimens are currently considered effective will not be altered. The advisory committee will be chaired by the KDHE secretary or a designee.
Its membership will include two psychiatrists nominated by the Kansas Psychiatric Society, two psychiatrists nominated by the association of community mental health centers of Kansas, two pharmacists nominated by the Kansas Pharmacy Association; one physician nominated by the Kansas Medical Society; and one advanced practice registered nurse nominated by the Kansas State Nurses Association.
The nominee will be selected by the KDHE secretary. At least one of the psychiatrists must specialize in treating children; another in caring for the elderly.
“The hope now is that this committee’s representation will be broad enough to cover the concern of all our constituencies and patients.” said Dr. Eric Atwood, a psychiatrist and medical director at Family Service & Guidance Center, Topeka. If KDHE and KDADS “are approaching this in good faith and if the spirit of this is to ensure safety, I think this can be a workable process,” Atwood said.
The compromise bill requires that the advisory committee meet at least four times a year. Consumer representation absent from committee Rick Cagan, executive director for the Kansas chapter of the National Alliance on Mental Illness, said his consumer constituents are noticeably absent from the proposed advisory committee. “No one consulted us,” Cagan said. “At this point, it looks as though there won’t be a consumer on the committee.
That’s a disappointment, but there don’t appear to be any representatives from the managed care companies on there either.”
Three private managed care companies operate the KanCare program for the state. Cagan said he remains troubled by KDADS and KDHE’s assertion that regulating access to mental health drugs will save millions of dollars. “They say that,” he said, “but that’s not been substantiated and I don’t see it happening.”
Dave Ranney is a reporter for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas.