National Health Reform Bill Signed Into Law

April 2nd Update:

The Bazelon Center for Mental Health Law released its summary of the new Health Care Reform Law (“Patient Protection and Affordable Care Act”) listing the many benefits to people with mental health and substance abuse issues. Bazelon Summary

For more information, visit Bazelon’s webpage on Health Care Reform: http://www.bazelon.org/issues/healthreform/index.htm.

March 25

“On March 23, President Obama signed the Patient Protection and Affordable Care Act into law. This moment marks a seismic shift for health care in America, taking our country forward toward joining all the other industrialized nations in providing a national plan to bring affordable health insurance coverage to millions of Americans, including 125,000 uninsured Maine people.”

So begins an open letter from Wendy Wolf, President & CEO of the Maine Health Access Foundation (MeHAF). The letter gives MeHAF’s overall perspective on the law, as well as key points and resources to help understand what the law means. To read the letter and access information and documents linked within it, CLICK HERE. Feel free to comment below. What do you think?

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Maine Rights of Recipients of MH Services

As some already know, the Maine Rights of Recipients of Mental Health Services (RRMHS) is undergoing a revision process. On January 4, 2009, the Office of Adult Mental Health Services (OAMHS) released its draft of the revised document and asked the consumer community to review and comment upon it before proceeding through the steps to finalization.

Helen Bailey of the Disability Rights Center (DRC) gathered consumer feedback and comments through the Advocacy Initiative Network (AIN), Consumer Council System of Maine (CCSM), Maine Association of Peer Support and Recovery Centers (MAPSRC), DRC’s Protection and Advocacy for Individuals with Mental Illness (PAIMI), and DRC staff. Helen compiled all of the comments into a report submitted to Tom Ward, Grievance Coordinator for OAMHS, on March 10, 2010. A representative from each of the groups mentioned above will meet with OAMHS staff on April 6th for a final discussion, before the rulemaking process begins (after which OAMHS may not discuss any of the revisions).

See the documents below for more thorough information:

MRRMHS (Nov. 1994)
MRRMHS Revised Draft
Report/Comments on Revised Draft

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Sharing Information and Confidentiality

CSN 5’s Continuity of Care Work Group just sent out a survey asking consumers about how they would like their information shared among the providers from whom they seek services. How to share information in order to receive good coordination of care and still maintain appropriate confidentiality is an important ongoing issue for consumers and providers alike statewide.

If you live in Androscoggin, Franklin, or Oxford Counties and you wish to complete the CSN 5 Survey, click here to download it. If not, please read it to get your thoughts flowing, and share your views and ideas in the comments section below.  Thank you!!

(Completed surveys can be returned to the CCSM, and we will pass on to our CSN 5 representative, Grace McDonald, who serves as co-chair of the Continuity of Care Work Group. See Contact Us for address.)

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CCSM Nominees Appointed to Review Board

The CCSM’s two nominees for Maine’s new Mental Health Homicide, Suicide, and Aggravated Assault Review Board (MHHSAARB) were successfully appointed by the Governor’s Office of Boards and Commissions! Holly Dixon and Simonne Maline will fill two of the three seats reserved for nominees of statewide organizations that advocate for the rights of persons with serious and persistent mental illness. Both Holly and Simonne bring experience and expertise to the sensitive and difficult work of this high level board. Holly serves as an elected representative to the Statewide Consumer Council (SCC) and directs the Peer Services program at Riverview Psychiatric Center. Simonne also serves on the SCC, holding the office of vice-chair, and directs Sweetser’s Learning and Recovery Center in Brunswick. Congratulations to Holly and Simonne and celebrations all around for consumers having voices in high places!

Other MHHSAARB nominees are unknown to us at this time, but categories include criminal defense attorney, psychiatrists, law enforcement, commissioners, judge or justice, prosecutor, assistant attorney general, mental health service provider, and victim-witness advocate. The MHHSAARB exists under Title 34-B Section 1931 of Maine Statute and shall review homicides, suicides and aggravated assaults involving a person with severe and persistent mental illness. The board will make recommendations to address prevention of such incidents and will submit reports to the Legislature’s Joint Committee on Health and Human Services.

Is this a good day or what?!

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CCSM Presents Crisis System Redesign

March 22 Update:

Good news for Maine’s Crisis Services! Because Maine will receive substantially more Federal Medicaid funds than previously expected, proposed cuts to several key services have been partially or entirely restored in the latest budget “change package” from DHHS.  Crisis Services were fully restored to the tune of $2.2 Million (adults and children). These general fund dollars are “flexible” in that they can be used for non-Maine reimbursable services, most importantly peer support services, key to a recovery-oriented crisis system. More on this soon.

February 19

In the midst of budget cuts facing Maine’s Mental Health Crisis System and providers scrambling to propose cost savings and streamlining efforts, the CCSM brought forward a system redesign plan that would revolutionize (recovery-ize?) crisis services here in Maine. This redesign, a vision developed by Scott Metzger, fellow-peer and Director of Peer Services at Sweetser, proposes a recovery-based merging of clinical and peer-recovery models. It expands the crisis system to include the Maine Warm Line, mobile support teams with peer support specialists, peer respites, and other recovery opportunities. This vision more holistically meets the needs of people who access the crisis system, many of whom are experiencing emotional distress that does not rise to the level of a crisis intervention, whose real and longer-term needs currently go unmet. (To see presentation slides, click here.)

The response to the initial presentation to the Office of Adult Mental Health Services on February 3rd was enthusiastic and encouraging. The following week, the design went to DHHS Commissioner Brenda Harvey, along with various other proposals for savings or changes DHHS received from crisis providers around the state. She expressed support of the vision and personally thanked the CCSM’s Executive Director for the “great work” that was done. The proposal then went to Rep. Mark Eves, the legislative liaison from the Health & Human Services Committee assigned to work with providers and DHHS to find possible solutions to the proposed cuts to crisis services. He, too, was impressed with the plan and reported out to the entire HHS Committee that while it does not provide immediate cost savings for the budget crisis, the proposal describes what should be the future direction of crisis services in Maine.

On Feb. 18th, Scott and the CCSM presented the proposal to a meeting of nearly all crisis providers in the state, several officials from DHHS (including Comm. Harvey and Dep. Comm. Muriel Littlefield), as well as Court Master Dan Wathen. The overall response of providers was very positive and some changes are already being made or considered, most notably in the southern and coastal catchment area. The most significant barrier, providers said, is how to fund the peer support initiatives. (To be continued…stay tuned!)

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Involuntary Outpatient Commitment

March 26 Update:

ACTION: Call or write your state legislators and urge them NOT to pass the Majority Report on LD 1360.

March 22 Update:

More developments, and unfortunately not for the better. On Thursday afternoon, March 18, the HHS Committee voted to reconsider LD 1360. Senators Mills and Nutting offered yet another amendment to the minority report for the Committee’s consideration. A motion for a vote was quickly made and seconded to approve this amended version, and after relatively brief discussion of the amendment, they voted 8-4 to pass. This vote shifted the former minority report to become the majority report, adding to the likelihood of the bill passing when it reaches the full house and senate, though that is not a forgone conclusion by any means. The house and senate will consider both the majority and minority reports and may pass either or neither version. For details, see Majority Report and Minority Report, after voting on March 18.

Since last year to now, LD 1360 has undergone many changes, thanks in great part to the hard work of stakeholders opposed to the bill. The amendments considered in recent work sessions looks very little like the original bill, thankfully. However, this last amendment that is now the majority report does differ from the most previous amendment. Helen Bailey of the Disability Rights Center offers the following synopsis:

“In the new amendment, the provisions that would have allowed the court to appoint a guardian or conservator, have been removed.The new amendment also removes the provision that would have permitted the court to issue an order that would have permitted the agency supervising the PTP to forcibly administer medications.  These were two provisions that we objected to.  The amendment also fixes a few technical problems we pointed out and some ordering problems.  But otherwise there were no further amendments adopted that we suggested.

The new amendment also adds some troubling provisions.  The court now is only required to appoint one independent examiner in both inpatient and PTP commitment hearings.  Both the inpatient and PTP commitment hearing can also be continued for a period of 21 days, up from 10, extending the period of time a person could be hospitalized prior to hearing to 38 to 40 days.  That examiner could be the individual who initiated the blue paper and/or signed the certificate upon the person’s being in the hospital for 24 hours because the provision requiring this independence has been removed.  The commitment period to the PTP has been increased from an initial 6 month period to 12 months.  The extension period in both amendments is 12 months.

The increase in the continuance period and the reduction in the number of examiners were apparently made after considering the financial implications.”

For more details from Helen’s analysis, please see her line-by-line comparison of the lastest amendment with the previous amendment HERE.

February 18 Update:

The Health & Human Services Committee held another work session on LD 1360 on February 17th. The majority of the committee voted only to approve Question 1 (see below), and repeal the “sunset” on the progressive treatment program [PTP] and continue it with a new sunset date of July 1, 2014. (“Sunset” is the date the legislation will “die” if not renewed again). They also emphasized that DHHS needs to provide adequate reporting and data on the progressive treatment program as it moves forward, including before and after (longitudinal) information and outcomes for those ordered to participate.

The majority agreed that changing Maine’s involuntary commitment laws should be a thoughtful, comprehensive process that involves all stakeholders. It appeared from the discussion after the vote that Senator Mills intends to present another draft of the bill that either takes out certain highly problematic elements of the current version or addresses committee members’ concerns raised during the discussion.

Another important part of the work session was around the costs associated (“fiscal note”) with the proposed legislation. DHHS maintains there would be costs involved in services and the Administrative Office of the Courts also raised substantial concerns about increased court costs for the required independent examinations, as well as strains on District Court dockets. The proponents (people in favor) of LD 1360 raised questions about increased costs, emphasizing their intention that the proposed bill would not require any additional funding.

The committee discussed the major decision points of the bill outlined in the form of 5 questions:

Question 1: Whether to extend the progressive treatment program [PTP] past July 1, 2010?
Question 2: Whether to extend the progressive treatment program [PTP] to persons being discharged from Acadia Hospital and Spring Harbor Hospital?
Question 3: Whether to extend the progressive treatment program [PTP] to persons who are involuntarily committed (white paper) as an option for the Court instead of involuntary hospitalization?
Question 4: Whether to extend the length of time of an order of involuntary treatment [in hospital] from 120 days to 6 months, with an extension period of up to 1 year?
Question 5: Whether to revise the involuntary commitment laws: decreasing the number of examinations from 4 to 3, simplifying the definitions of “likelihood of serious harm” and providing a definition of “medical practitioner” and, with reagrd to the progressive treatment program [PTP], allowing applications to be filed by the ACT team or Commissioner, providing the Court authority to enter orders to ensure compliance with the treatment plan, and simplifying and shortening eligibility, notice and hearings provisions?

 


The latest amendments to LD 1360 in part reflect the “4th option” for involuntary commitment (described below), but does so by changing existing laws for involuntary commitment to psychiatric hospitals and the Progressive Treatment Program (PTP) law. In addition to allowing for limited involuntary outpatient commitment (which the vast majority of Maine consumers stand firmly against), changes in wording and other things included in the amendments give rise for concerns and objections.

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