[NYAPRS Enews] Advocacy Continues on BHO, Pharmacy, Adult Home Resident Housing Proposals

[Harvey Rosenthal]

NYAPRS Note: Advocates are working strenuously to shape the final state
budget agreement many think will be negotiated over the coming weekend
between the Governor and the state legislature. With regards to the
Medicaid Redesign package, NYAPRS has been actively advocating for: 

*         preserving the language and provisions surrounding the
establishment of regional behavioral health care organization-managed
care coordination initiatives over the next few years and is urging the
Assembly to support executive provisions providing for prompt
procurement, vesting oversight authority (including consumer and benefit
protections) with OMH/OASAS. 

*         keeping pharmacy out of managed care and retaining prescriber
prevails protections.

We've also been urging the Senate to preserve and rather than re-program
$41 million in supported housing for adult home residents with
psychiatric disabilities. 

Stay tuned for some suggestions as to how you can help!

 

Budget will Likely Include Portion of Medicaid Redesign Package

By Cara Matthews  Gannett News Service  March 17, 2011

 

ALBANY -- Senate and Assembly lawmakers say their budget proposals would
largely implement the recommendations of Gov. Andrew Cuomo's Medicaid
Redesign Team, but there are key differences that have to be worked out
in medical malpractice, prescription drugs and other areas.

Dozens of recommendations from the Medicaid Redesign Team's recent
report to the governor were included in Cuomo's amended budget proposal.
Not everything is expected to make it into the 2011-12 budget intact,
and the Assembly and Senate have staked out their negotiating positions.

"I think it's fair to say both of us are largely on board with the MRT
package and both of us and our conferences disagree on some things,"
said Assembly Health Committee Chairman Richard Gottfried, D-Manhattan,
said Wednesday.

Senate Health Committee Chairman Kemp Hannon, R-Nassau County, said the
Medicaid proposals make this year different from previous ones.

"I think the innovation there was something new. We hadn't seen that
before," he said. "It used to be we'd just be fighting over numbers, so
they have opened up the arena substantially."

One of the most controversial recommendations is to place a $250,000 cap
on damage awards for pain and suffering and set up an indemnity fund for
infants with neurological impairments.

The Assembly opposes the cap and wants to amend the proposal for the
indemnity fund by setting up a work group that would advise hospitals on
how to reduce birth-related neurological injuries and approve
obstetrical patient-safety programs.

The Senate supports the proposal but wants to change it to include
medical-malpractice reforms, such as supplementing premiums in hospitals
that implement comprehensive patient-safety measures.

AARP and other patient-rights groups, including Citizen Action and the
New York Public Interest Research Group, oppose the cap. The New York
State Medical Society support it.

"This proposal will hurt many consumers, particularly seniors, by making
it much harder for these individuals to obtain justice in the courts
when they have been injured by the negligence of others," Lois Wagh
Aronstein, AARP New York director, said in a statement.

Lawmakers adopted the budget resolutions Tuesday. Conference committees
to work out differences between the two houses' budgets have begun to
meet. The budget is due by the April 1 beginning of the 2011-12 fiscal
year.

The governor's budget also includes a cap on Medicaid spending and
limits on future growth, rate reductions and an end to automatic rate
increases. Nearly five million New Yorkers receive Medicaid, a
health-care program for the poor.

The proposals would save $2.3 billion. New York spends more than twice
the national average on Medicaid on a per capita basis.

Home-care workers may not get their wage increases, which was a key
factor in getting 1199 SEIU United Healthcare Workers East to support
the Redesign Team's recommendations. The plan calls for boosting the pay
of direct-care workers over three years.

The Assembly includes this in its budget, but the Senate does not.

Kevin Finnegan, political director for 1199, said the union is
disappointed but hopeful the budget will include the increases. Roughly
50,000 workers would be affected, he said.

"It's a one-house bill," he said of the Assembly budget. "They're not
locked into it. There's a lot of positioning and posturing that goes
into one-house bills. People are taking bargaining positions."

The New York Association of Homes and Services for the Aging opposes the
pay hikes, saying they could lead to layoffs.

Other groups are lobbying against a proposal that would give the state,
and not physicians, the final say regarding prior-authorization of brand
drugs that aren't on Medicaid's preferred-drug list. It would require
prior authorization to prescribe medication for people with lupus,
HIV/AIDS, mental illness, kidney disease and other chronic illnesses.

"Those with mental illness who are unable to access the most
appropriate, clinically indicated psychiatric medication experience
higher rates of emergency department visits, hospitalizations and other
health services," said Matthew Shapiro of the National Alliance on
Mental Illness in New York.

The Senate budget resolution rejects that element in the governor's
budget and would give the provider the final say. The Assembly's does
not, but the repeal of so-called "physician prevails" would be in place
for one year, Gottfried said.

The New York Nurses Association is running an advertising campaign that
urges lawmakers and the governor to "go slower" on implementing the
Redesign Team's proposals.

"Our members, who take care of patients every day, want to remind our
legislators that the state budget isn't just numbers on paper, but
represents resources that affect the care and well-being of real
people," Tina Gerardi, CEO of the group, said in a statement.

http://www.stargazette.com/article/20110316/NEWS01/103160388/Budget-like
ly-will-include-portion-Medicaid-Redesign-package?odyssey=tab|topnews|te
xt|FRONTPAGE

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Fight Brews Over Prescription Cost

Senate Rejects Medicaid Rule For Doctors; Change Approved In Assembly

by Cathleen F. Crowley Albany Times Union  March 17, 2011

 

Patient advocates praised the Senate on Wednesday for rejecting two
proposals that they said would deny doctors the ability to prescribe the
best drugs for patients.

The state Medicaid Redesign Team has recommended prescription management
policies that steer doctors and patients toward cheaper drugs deemed
equally effective. The redesign team also proposed eliminating the
"prescriber prevails" rule, and instead would make the Medicaid director
the final authority on doctors' requests to use drugs that are not on
the Preferred Drug List.

Rebecca O'Keefe, of Loudonville, said the proposals would hurt her
10-year-old son, Alex, who had a kidney transplant five months ago. Alex
takes two brand-name anti-rejection drugs, and she fears he would be
forced to take generic versions that have never been tested on children.

"For the state to alter his medication when he is doing so well is
appalling," O'Keefe said.

Senate Republicans are leading the effort to reject the proposed changes
to the prescription drug program, but the Assembly budget plan includes
the measures.

"It's important that we look at the personal side of health care, not
just the monetary side," said Sen. Kemp Hannon, chairman of the Senate
Health Committee, who spoke at a news conference sponsored by several
advocacy groups including the National Kidney Foundation, the National
Alliance on Mental Illness and the Lupus Foundation of Mid and
Northeastern New York.

The redesign team estimates the two proposals would save the state $139
million annually. In many cases, patients would have to try generic
drugs before being allowed to take brand-name drugs.

Diane Mathis, a spokeswoman for the state Department of Health, said the
proposals would have no negative impact on Medicaid patients because no
drugs are excluded.

"The goal is to give patients access to the most cost-effective drug,"
Mathis said. "The current mechanism known as 'physician prevails' that
allows physicians to override New York's Preferred Drug List is very
seldom used. It was utilized by physicians during the past year for only
3,000 out of 50 million Medicaid prescriptions."

Taxpayers are currently paying more for prescription drugs than they
should because the physician-prevails rule weakens the state's ability
to negotiate with pharmaceutical companies to get the best prices and
drug rebates, Mathis said.

Still, advocates are lobbying the Assembly and Gov. Andrew Cuomo in
hopes of convincing them to reconsider the prescription drug changes.

"Eliminating the existing safeguards will only jeopardize patients'
health and deny them necessary medical care," said Kathleen Arntsen, of
the Lupus Foundation.

http://www.timesunion.com/default/article/Fight-brews-over-prescription-
cost-1164413.php#ixzz1GrqLuzVt 

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