Taxing & Spending

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

hootontootin — Sat, 03 Oct 2009 13:13:56 GMT

It seems to me that everytime there's a vote to take spending away from an appropriation,it's always the helpless individual that suffers the consequences,with out even realizing that it happens to them!!

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:17:26 GMT

Senator Kahn’s fourteenth statement is as follows:

With great reluctance, I rise to oppose this amendment. The amendment is not well written. It says, “(i) The department shall comply with and reimburse a prescription containing a doctor’s dispense as written order for all behavioral health patient prescriptions.” That would include high blood pressure pills, heart pills, diabetes medications, and on and on.

As part of the discussion that we have had on this entire subject today, there is a message and that is to get it right and get some protections in. There isn’t a message that we want to back away from everything we have ever done and every other part of the dispense as written versus prior authorization P&T committee actions.

So this amendment, I understand why it is here, but it is poorly written or unfortunately written—is a nicer way to say it. I would look forward to working with Senator Brater to give some of the protections she would like as we go through the process of policy bills and bills in Appropriations.

Senator Cherry’s eighth statement is as follows:

I hope that the good chairman of the subcommittee would reconsider his opposition to this amendment. The words “behavioral health” are an accepted term of art which refers to medication for brain disorders. It’s pretty clear that what we’re talking about is specifically the issue of psychotropic drugs. I believe that these are all verbal assurances that have been given to us through subcommittee meetings and from department discussions. It seems to me it makes sense to put them in writing in boilerplate in the bill so that we’re very clear about this policy.

I hope, I hope that the chairperson of this committee would reconsider his opposition to this amendment and place this language into the bill. As we’ve heard from members, there’s experience regarding this issue from a wide variety of perspectives within the membership of this body. I think it’s only fair to have some language to reassure us that what we are doing does not jeopardize the mental health of any citizen of this state. I ask that the chair reconsider his opposition and all of us vote in favor of this amendment.

Senator Kahn’s fifteenth statement is as follows:

In concluding remarks before we vote here, I’d like to thank Senator Cherry for her passion and for the things that we could work on together and advocate for together; Senator Pappageorge, the majority vice chair, for his work; and all the committee members: Senator Barcia, Senator Switalski, Senator George, and Senator Stamas.

This budget, as proposed, as Senator Cherry points out, has weaknesses. Those weaknesses are a reflection of the weaknesses in our economy. They are not weaknesses in caring or wanting, as Senator Cherry so well points out.

But there are some good things in this budget. Let’s close with some of the positives. There’s restoration of the CMH multicultural line item, which funds folks in southeast Michigan in particular, but actually all across the state, who are in need. Some small clinics have been restored. Early childhood collaborative secondary prevention and nurse family partnerships were restored. A priority in this budget was staked out for children—for children. We found in the adult home-help community that the folks who work there are just dramatically under-supported and that’s helped too. We improve the institutional memory, the ongoing retention of employees and, therefore, the quality of care that is delivered by these folks. We even found a way to move towards a new idea for Healthy Kids dental, adding it to Sterling Heights, Macomb County, and Highland Park in Wayne County—both communities with children in need.

As we move on, hopefully, to pass this budget and then to the conference committee, you can defend the notion that this budget with its cuts defended children. I ask for its passage.

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:16:47 GMT

Senator Gleason’s second statement is as follows:

I believe we made a lot of tough decisions today which we didn’t necessarily have to make. I think we are about to do that again right now. People are saying that we must cut, but do we really have to? Now there has been an option which has been presented to us a few weeks ago saying that maybe we don’t have to make all of these cuts; that maybe we do have a funding stream which we haven’t yet had the courage enough to address.

Pretty much most of today, we have put our citizens at greater risk, and in many cases, harm’s way by cutting these budgets. But why don’t we take the responsible step and put our sick, ailing, and invalid citizens ahead of certain tax credits? Why don’t we look at an approach about funding some of these ailments instead of always cutting? Why do we cut things which are vital to our families?

About an hour and a half ago, it was said, well, this is what we signed up for. I didn’t sign up to cut any sick persons’ benefits. That’s not what I signed up for, but we’ve been doing that pretty much most of today. So I think it’s high time we take a serious look when we’re giving special treatments to special interests over sick people.

Let’s take a responsible look at tax credits. I’m one who says let’s put them all on the table, those which may be favorable to the Democrats and those which may be favorable to the Republicans. But let’s quit putting special interests above sick Michiganians. We’ve done that for too long. The constant remarks in regard to the amendments today trying to stand up and afford some sense of relief for our sick constituents in everyone’s district in all parts of the state should be met with an equal, maybe a higher, responsibility—look at tax credits. Why give special treatment, special breaks, and funding opportunities to special interests over sick and dying Michiganians?

We can do better than this. There’s not a single person in this room who would stand by if they had a sick child or a dying parent to say that we can’t find a purpose in setting aside some tax credits for funding the sick and the ailing. So let’s look at this closer. We can do better than this and we should.

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:16:11 GMT

Senator Cherry’s seventh statement is as follows:

I only want to add my words to support of this amendment. I also have had experience personally with family members, and I know how important it is to have a good balance of medication. I don’t care what we talk about in terms of what we think will happen. There is a problem with changing this. I hope that members will continue to vote for the Brater amendment.

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:15:34 GMT

Senator Olshove’s statement is as follows:

I do believe there are many people in this chamber; in fact, the good doctors who may be speaking from a practice that they haven’t been at. I have experienced the situation that we are talking about. I think if you recall, it was four and a half years ago I came back to this microphone after going through a very tough time. I’ve gone through that time over and over again over the last few years. I wouldn’t wish that on anybody.

To change this is putting many people in jeopardy—people with epilepsy, people who can actually hurt people on the road—should they not be able to take the proper medication that they have attained a balance with. It is very tough to establish a balance. If that is jeopardized, or if some board with some doctors come and tell you that you are not entitled to that drug or it’s not on our list anymore or if I have to fight for that drug to reestablish some balance, to establish some safety on the road, I think it is unconscionable that this body would approve that.

I would appreciate your “yes” vote on the Brater amendment please.

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:15:00 GMT

Senator Switalski’s statement is as follows:

I appreciate the dedication and diligence that Senator Brater brings to the job and her tireless advocacy for the mentally ill. I also appreciate the comments from my good colleague, Senator Olshove. But I think the problem that he lays out is changed in this legislation. It is not the same as it was some years ago to the point where if you are on a type of psychotropic drug, you would be allowed to continue that. So that is a significant change from what it was in the past, and I think it would deal with the situation he is describing.

Reluctantly, I am going to vote “no” on this amendment. I believe discussion on this policy change must go forward. This is not a partisan issue. The EO eliminated this carve-out, and it was supported by both parties. The Governor’s budget also eliminated this carve-out. The House disagrees with us and wishes to maintain the status quo, but I believe this issue should advance to the conference table and so a point of difference is justified. If we have this and the House doesn’t have this, this can be settled at the conference table. Defeat of this amendment would allow this to go forward to the conference committee.

Only in the context of making actual choices can we come up with good policy. The actual choices are we do have to cut $7.5 million. If we don’t cut it on this item, we’ll be cutting it on some other item. It’s best that we make a choice between alternatives. I believe that everything should be on the table, therefore, I am going to vote against this amendment.

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:13:56 GMT

Senator Kahn’s twelfth statement is as follows:

I rise in opposition to this amendment. Like the amendment prior, it was first seen by me today. It avows some considerable policy issues, as well as some funding issues, where the money is coming from and how county-shared plans and third-share plans would lose $5 million here, if I read this correctly. It is brand new for me to read.

How it will all be dealt with is also unclear, and therefore I oppose this amendment. I ask for its defeat.

Senator Hardiman’s statement is as follows:

This amendment is a very simple one. It simply adds a $100 placeholder for coordinating information between the LEIN system and the new Bridges DHS system. Obviously, this affects the community health in that the DHS staff do eligibility for Medicaid. This continues the policy from the current fiscal year. It is important to ensure assistance payments only go to those who are entitled to them, especially in this very difficult time of budget cutting. I ask the body’s approval of the amendment.

Senator Kahn’s thirteenth statement is as follows:

I would like to thank Dr. George for his comments. Among the concerns which have been raised in changing the preferred drug list are about safety for our patients, efficacy for our patients, the behavior or potential behavior of the department, and on your desk to address that I gave you a one-pager.

I would like to talk about addressing prescriber concerns and consumer concerns. When a prescriber requests a non-preferred drug, he or she must attain prior authorization; therein is the rub. A step-added process is what it is called. It can be employed upon the recommendation of the pharmacy and therapeutics committee and allow prescriptions for certain non-preferred drugs to proceed without the need for prior authorization if a preferred drug has been previously prescribed. You don’t have to have prior authorization if you are already on it.

The prior authorization process has become more sophisticated and streamlined, and a prescribing doctor who needs to use it can use toll-free telephone lines, toll-free fax lines, and a secured Internet-based web for prior authorization. It can be accessed 24 hours a day, 7 days a week. There is even capacity to bypass the need for prior authorization by simply writing a diagnosis code on the prescription; simply write a diagnosis, no prior authorization.

Addressing consumer concerns, all individuals currently using a psychotropic drug identified as non-preferred by the pharmacy and therapeutics committee will continue to receive their existing prescriptions without prior authorization.

The Michigan Department of Community Health will communicate extensively with consumers, clinicians, advocates, and the pharmacy communities during all phases of the implementation process to ensure many opportunities for input are provided. The goal is to ensure that the best and most appropriate psychotropic medications remain available and accessible to the people we serve.

In my office, I had multiple meetings with folks who are lobbyists for the pharmaceutical community. They brought me papers, medical papers, many of the. I don’t know maybe eight, nine, ten on up. In the bulk of the papers brought to me, they had little carve-out sections—talking about a carve-out—where they mention what would be a good preferred drug list and how it could work. I sent these to the Department of Community Health. Michigan is doing these things already.

I leave you with this last restatement. What the department currently has contains even the capacity to bypass the need for prior authorization by a physician by simply writing a diagnosis code on the prescription.

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:13:13 GMT

Senator Gleason’s first statement is as follows:

We have been discussing funding priorities here for most of the day. I think one of our greatest obligations is to make sure that we offer health care to the uninsured, particularly those who would like to have the insurance. Over the past few years, it has been discussed that many Michigan citizens do not prefer the insurance coverage. For those who lose their jobs today, and we know there is too many of them, they have an opportunity to purchase COBRA.

There are a lot of things I would like to purchase too, but I can’t afford them. COBRA falls into that wish list, except that is not only a wish, but it is a need for many families. What my amendment does is ask that we make COBRA somewhat more affordable for families here in Michigan, those who are uninsured and would like to have it. I have a simple request—I think it is a benevolent request—to put back $5 million into the COBRA fund, so that we have it subsidized for the families that don’t have it.

Far too often, we have talked about preventative care rather than accumulative crisis care. If we offer these families and potential carriers of COBRA a chance to have affordable health care, maybe they can get in sooner to prevent some of the long-term ramifications that we lose by not having early detection, whether it is high blood pressure, sugar diabetes, or other health concerns.

I ask that we consider this and support it to make health insurance more affordable. It is $5 million, and I think we can help many people who would request it. I am here speaking for those who would like to have COBRA but can’t afford it. I think we have the ability today to make that much-needed insurance affordable.

Senator Kahn’s twelfth statement is as follows:

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:12:38 GMT

Senator Whitmer’s statement is as follows:

Yesterday, I noticed that a number of members offered amendments to the higher education and community colleges budgets that went something like this, “If additional funding becomes available, the Legislature would like it to go to promise zones,” which is what the Senator from the 13th District said; or Michigan tuition grant, which is what the Senator from the 32nd District said; or renaissance zones, which is what the Senator from the 33rd District said. Truth be told, I was kind of surprised. What does it mean “if funding becomes available?” These were amendments offered by the same people who wrote the budget bills, after all, that slashed those very programs. So they were amorphous, feel-good amendments, I guess.

Well, that inspired me, not to do the same, but to look to save something I care about in these budgets with a very real, possible, measurable contingency. So here it is. My amendment provides that should we, the Legislature, repeal our one-in-the nation drug immunity law—the same law that precludes our citizens victimized by a dangerous pharmaceutical drug from recovery—if we decide to stop treating our people as second-class citizens and give our people the protections people in the other 49 states enjoy, then any dollars that the DCH recovers in their capacity as a third-party intervener under current law and in that capacity negotiates to recover Medicaid losses, those dollars—estimated based on others states’ recovery for the same to be in the realm of $30 - $80 million—those dollars would be used for the Medicaid adult dental services, school-based health centers, and expand the Healthy Kids dental program statewide to all 83 counties to kids in every one of our counties.

Talk about the proverbial win-win. We could right the wrongs we have perpetrated on Michigan pharmaceutical victims and shore up the safety net obliterated by this budget bill if we adopt this amendment and change the drug immunity law. I ask for your support.

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:11:59 GMT

Senator Kahn’s eleventh statement is as follows:

I appreciate the continuing passion of the Senator from the 23rd District on this issue. I didn’t have a chance to see this prior to today, but that probably, all in all, isn’t critical because, clearly, this is an area where we are contending between the parties now, and it really doesn’t belong in the budget bill. It belongs in debate before this floor in consideration of where we are going to go on this issue at a later time. I urge, therefore, its rejection.

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:11:32 GMT

Senator Scott’s second statement is as follows:

If there was ever anything that was truly, truly important in this budget, it is this amendment that I have. The Senator from the 18th District said most of what I wanted to say. The chair of the committee mentioned that it was equitable and that the CMHs had voted on this. Well, when you get an opportunity—and if Wayne County only got one vote out of that, of course, if they could take the dollars away for their community, they would do that. But I don’t think anyone realizes that there would be 4,000 inmates who are going to be released, and the majority of them in Wayne County—they even chose Wayne County—for all of these prisoners to be processed. I would hope that now that we know that they are coming out, we don’t have all of the dollars that are necessary, or at least we are not putting all the dollars in for these prisoners to come out. They are coming out so I think we need to have a change of heart and realize that it is going be very devastating if we don’t make some change in this formula.

I would ask that we would accept both of these amendments, and then later we can think about how we are going to do this. But at this time, we know it is truly important that we don’t use this new formula. It is disastrous, and it is on us because it is up to us to make a difference in this.

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:10:49 GMT

Senator Kahn’s tenth statement is as follows:

I thank, as well, the good Senator from the 2nd District with her unfailing charm. Let me address the first of these two. The first is the amendment labeled No. 12. We addressed that earlier in the amount of money that will be available through the CMH non-Medicaid line currently funded at $322 million and at that number before the roof or the basement or the sides of the building fell out in our budget house. That led of course to the reductions that you see.

I think, really, that the area that is new is Amendment No. 13 in the funding formula. Let me address that. The CMH non-Medicaid funding formula was the result of convening the mental health community in 1998, and that was the first time it was done. A funding formula to decide what was an equitable distribution of funds was created. What is a equitable distribution of funds? Equity was defined largely by a different word—”need.” Then, of course, you have the issue of what is need? Need became defined by proxies—things that would demonstrate that there was, in fact, some need. What were the proxies? Things like school lunch programs, crime rates in a community, and poverty. Those became the basis for that formula. It was applied that year. The following year, there were some concerns about it, and it was applied in another formula that was put together in 1999 or perhaps 2000.

Those formulas got into hot water because, like all formulas, they apply to all of us and not to just a certain segment of the population. There was no formula available until last year. When a community mental health organization got into some trouble, the mental health director would reach into his pocket or look into his budget, as it were, and find $1 million here or $1 million there to straighten out the scrape that the community mental health agency was in.

In a way to get beyond that kind of funding mechanism, a new round of meetings were held. Every CMH in the state was invited and a new formula was developed through their meetings. I had nothing to do with it. A new formula on equity was applied in the cuts that were part of the executive order last year. It is now part of how the department plans to fund next year. As such, it is deserving of the respect that its creation implies. Everybody was involved. Yes, there are some losers, but it is equitable. I urge the defeat of Amendment No. 13, as well as No. 12

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:10:14 GMT

Senator Scott’s first statement is as follows:

Amendment No. 12 would roll together all the CMH non-Medicaid funding lines and would restore funding to the Governor’s recommendation of $320 million or $54 million over the level currently in this bill. Amendment No. 13 is related and would restore the current year allocation formula for CMH non-Medicaid funding.

Current year allocations for CMH non-Medicaid funding are based on a distribution formula that has been in place for many years. This budget would change that formula in a way that I feel is grossly unfair. The new formula is perpetrated to be more equitable. However, just because of the formula change, Wayne County mental health services would lose $25 million or about 23 percent of their funding. This is on top of the $18 million they will lose as a result of the across-the-board cut to all CMHs. Detroit-Wayne would stand to lose a total of about $43 million or about 40 percent of their funding under this current budget.

How can we say this is equitable in any way? I know the department and many of the 40-plus other CMH agencies will argue that the new formula distributes money where it is needed. But, intuitively, we know that Detroit and Wayne County have the largest population of persons who need these services.

Wayne County has served a larger number of persons over the last several years than any other agency. Everyone should share in the pain of these difficult budgets. But to cut one agency by over 40 percent is outrageous. My two amendments would roll together the line item for CMH, restore funding to the Governor’s recommendation, and would maintain the current year funding allocation.

We must all keep in mind that we talked about it in another budget—the Corrections budget—that about 4,000 prisoners are coming out. These prisoners are being processed right now in my district, Mound and Ryan. The majority will be coming to Wayne County. We know that there are so many who have been incarcerated with mental health issues and so many who were incarcerated became mentally ill just being in prison. But these people will be coming out not because they are coming out earlier, but they have done their time and are being released. We need to make sure that we have the proper funding available when they come into the communities.

I would hope that you would think about this, and let’s do something about this one.

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:09:41 GMT

Senator Kahn’s seventh statement is as follows:

Indeed, it is true that the good Senator from the 26th District and I have discussed modifying this particular amendment, but we did not come up with the language that would allow us to do that. The notion of having a bid process is very sound, of course. Whether or not this amendment, as currently constructed, is going to be the ultimate expression of that process is uncertain. But since there is nothing like this in the House bill, we cannot remove this, or we will not have a point for discussion between the Senator from the 26th District and me. I urge the retention of this boilerplate and the rejection of her amendment, and the process will move forward.

Senator Cherry’s sixth statement is as follows:

This amendment deals with a program we provide in Michigan. It has both state and federal funding, and it is what is called the Michigan Essential Health Provider Program.” What it does is for medical professionals, doctors, nurses, and any medical professional who are going to school and get a loan, this program helps repay the loan if providers work in underserved areas. It seems, if we are trying again to lower costs of medical care, that this would be something we would want to do. We have a shortage of many medical professional in this state, especially in cities, urban settings, and rural settings. I really don’t understand why we are being short-sighted and cutting this program. I hope that members do support it, that we make sure that do have physicians, nurses, and medical professionals in underserved areas. This amendment does that.

Senator Kahn’s eighth statement is as follows:

I rise in opposition to this amendment. It is a worthy program. I went to school on loans myself. It would be great if there was the money available for this and also for the nursing programs that we addressed earlier today in terms of being able to provide funding and support for them. There are loan dollars available and would be an appropriate substitute for an individual seeking support to go through school to find that support through the loan programs.

So for the same reason that we have discussed the preceding nine amendments—dollars and our lack thereof—I urge the defeat of this amendment as well.

Senator Kahn’s ninth statement is as follows:

I greatly appreciate working with Senator Cherry on this budget. She is thoughtful, and her concerns here are also thoughtful. In the same sense, in Genesee County, which has an excellent medical community, they found that the most efficient way to deliver care is to coordinate it. It is true across the rest of the state. Taking substance abuse and artificially separating it from mental health is a mistake.

The number of people who have substance abuse problems who don’t have mental health issues is pretty small. Folding these two departments together saves us $1 million; gets rid of one level of administration; allows for coordinating care; and improves the delivery of that care to our people. It is for those reasons that they fixed the problem in Genesee and in many of our counties across Michigan. Coordinating agencies are apart of their community mental health organizations and PIHPs. This should be encouraged, and this existing language does that. I urge the rejection of this amendment.

Re: 2009 House Bill 4436 (Appropriations: 2009-2010 Department of Community Health budget )

Admin003 — Fri, 26 Jun 2009 00:09:00 GMT

Senator Kahn’s sixth statement is as follows:

I rise in opposition to this amendment. Our HMO networks across the state of Michigan are superb. We have four HMOs in Michigan that are in the top 25 in the entire nation, tow in the top ten. I don’t think there is really a question of degradation of care here. I think that on reflection, I would hope that the good Senator would agree with me that our HMOs are fine.

Really, the issue here is one of the funding. By making this transfer, patients, children may be reconnected with the rest of their family in the same HMO. That is probably the case, not just maybe the case. But in particular, because of the Medicaid matching rates that were brought up before as part of the issue in the cuts to providers, the state will see about another $2 million worth of income. It is an interesting number. That is about the same as the dollars we will be using to fund the MICR.

I urge the rejection of this amendment as a cost-savings measure for the people of Michigan and as a reuniter in an excellent HMO network community across our state.