|
 |
|
To find out who your legislator is call 202-224-3121. |
MD LEGISLATION
Alice Nealy
While Maryland legislators are involved with the upcoming presidential
elections, the executive branch staff has been moving forward on its own agenda.
Since the very popular 2004 legislation providing for consumer-driven safeguards for any future long term care managed care system was vetoed the Governor, Secretary Sabatini of the Department of Health and Mental Hygiene (DHMH) is proceeding to develop a program without the critical safeguards which were in the legislation.
This DHMH initiative is intended to address problems with the current long-term care system: lack of incentives for efficiency; inadequate flexibility; a fragmented system of care; increasing costs, and lack of care coordination for the 70,000 people who are covered by both Medicare and Medicaid (“dually eligible”).
Initiative Includes Mental Health Services
The program will involve not only the dually eligible, but also Medicaid recipients who qualify for nursing home level of care and all other Medicaid recipients age 65 and over, who will be required to enroll in a “community care organization” which would cover and coordinate all health benefits. Included in the system will be all specialty mental health services – including inpatient psychiatric services, community mental health programs and prescription drugs, all long-term care services - including nursing home, chronic hospital, personal care and medical day care, and hospice care.
Mental health advocates have expressed grave concerns about the impact of such a system on long term care populations who use or could use the public mental health system; They are urging that such users be exempted outright or at least be given the choice to opt out.
No Choice in “Community Choice”
More than 5,000 people with dual eligibility currently use the public mental health system, as do thousands more age 65 and over with Medical Assistance eligibility. The current system has extensive mechanisms in place to pre-approve care and determine type, frequency and duration of services based on medical necessity and available resources; these community services are highly effective in delivering lower cost alternatives to institutional care to very vulnerable individuals.
In short, the goals of the proposed system are already being met for persons served by the public mental health system. Forcing them into new "community care organizations" would not only increase fragmentation and duplication but would endanger the very community tenure the new system hopes to promote.
How ironic that a “Community Choice" program would deny choice to thousands of Marylanders with psychiatric disabilities. Our position is that all persons using or eligible for the public mental health system should be exempt or, at the very least, be given the choice to opt out of Community Choice.
A Coalition of Health Providers
A coalition of health care lobbyists
and leaders of professional organizations who have taken an active part in
legislative reform has convened to discuss proposed legislation for the 2005
legislative session. I attend these meetings to represent your interests and
have been asked to give feedback on the Maryland malpractice problems as it
relates to social work practice. The topic of social workers as expert witnesses
has also been a part of these discussions.
Lastly, in discussions with legislators who worked so hard to pass legislation
to cover the uninsured, only to have the bill die at the final minute of the
session, I have learned that access to health care for all consumers will be
back in the 2005 session.
Alice J. Neily of Capital Consultants is legislative advocate representing
the Maryland Legislative Council of Social Workers, a coalition of the Greater
Washington and Maryland clinical societies, NASW-Metro DC, and the Association
of Social Work Administrators. Her website is
http://www.capitalconsultantsofmd.com.
A 24- page summary of the
Department’s proposed initiative is available; contact GWSCSW at 202 537 0007 or
at GWSCSW@gmail.com.
**Call your legislator to urge that users of the public
mental health system be permitted to opt out of the proposed long-term managed
care initiative**