N.J. Bucks National Trend, Enhances MH Services

Oregon's Senate passed a parity bill (S 1) in June that got “caught up in the deal making of the last days of the Legislative Assembly,” reported the Oregonian on June 13.

The Oregonian, however, had harsh words about the process.“ If this sausage making is hard for the public to stomach, imagine how it looks to the exhausted families that have spent themselves into bankruptcy trying to get care for their mentally ill children.”

The column, part of a series titled “Oregon's Forgotten Hospitals,” describes the struggles of two families to get help for their sons. The unnamed author wrote that the bill “is a declaration that Oregon families should not have to lose everything, even custody of their children, to the hell of a mental illness.”

House Republican leaders refused to let the bill come to the floor for a vote and were holding out for concessions on a proposed capital gains tax cut, according to the column.

Mississippi has imposed additional limits on access to medications for Medicaid beneficiaries, according to the Web site<www.kaisernetwork.org> on June 16.

Under the policy, which was scheduled to take effect July 1, beneficiaries will be allowed prescriptions for five drugs a month, two of which are brand-name medications and three of which are generic medications. Beneficiaries had been allowed up to seven prescriptions a month.

The HIV Medical Association sent Gov. Haley Barbour (R) a letter charging that the policy could result in “substandard HIV care” because generic antiretrovirals are not available, and most HIV/AIDS patients need at least three antiretrovirals to treat the virus effectively.

Restrictions on access to medication also are a part of Tennessee's effort to restructure TennCare, its Medicaid program.

The most recent proposal of Gov. Phil Bredesen (D) to the Centers for Medicare and Medicaid Services (CMS) for changes to TennCare would limit monthly prescription coverage to two brand-name medications and three generic medications and introduce copayments of $3 for brand-name medications for beneficiaries with incomes above 100 of the poverty level. The proposal would permit establishment of a preferred-drug list and limit rights to appeal. Nearly 400,000 adult beneficiaries would be affected by the change.

In Louisiana, physicians prescribing medication for Medicaid patients must receive prior authorization for medications not on a preferred drug list. However, antipsychotic medications and those used to treat hepatitis C had been exempt from these requirements, but last month a bill to eliminate that exemption received final legislative approval. The bill will go to Gov. Kathleen Blanco (D), who is expected to sign it.

South Carolina submitted to the CMS a plan that would provide Medicaid beneficiaries with personal health accounts to purchase public or private health insurance, according to the Web site<www.kaisernetwork.org> on June 21. The plan would also include higher copayments for services.

The proposal assumes that insurers would offer a variety of plans, ranging from those with low costs and limited services to comprehensive HMO plans. Beneficiaries would receive debit accounts to pay for additional out-of-pocket costs and copays.

For each debit account, the state would earmark an amount similar to the amount state residents spend on private-sector health care.

The Michigan Senate approved a Medicaid bill that would charge beneficiaries an average $5 monthly premium, but would reduce that premium if a beneficiary agrees to sign a pledge to lead a healthy lifestyle. A healthy lifestyle would include abstinence from tobacco and an annual checkup, for example.

Beneficiaries who are pregnant, are in nursing homes, or have disabilities are exempt from the premium.

The bill would establish a $10 copay for a brand-name prescription medication if a generic is available and a $25 copay for nonemergency visits to emergency rooms.

The Senate failed to approve Medicaid enrollment reductions that were in the House version of the bill. ▪