By Dave Ranney 

A Senate-rejected bill meant to allow KanCare, the state’s privatized Medicaid program, to regulate mental health patients’ access to antipsychotic medications is making a comeback. Kansas Department for Aging and Disability Services Secretary Kari Bruffett on Thursday said she hopes to introduce a revised version of the bill within the next few weeks.

The intent of the new bill, she said, will be to ensure patient safety without jeopardizing ready access to mental health drugs.

“I’m very encouraged by the conversations we’ve had about building in some of the guardrails and policies that we’ve talked about to ensure that medications are safely prescribed and we’re not seeing medications being prescribed at unsafe dosages or inappropriately for children, while at the same time also ensuring that people get the meds they need to live and thrive in their communities,”Bruffett said during a morning session of Mental Health Advocacy Day, an annual gathering coordinated by the Kansas Mental Health Coalition.

More than 300 people — a mix of mental health consumers, case managers, providers and advocates — attended the meeting in the Ramada Inn ballroom.

Last month, many in the audience lobbied against the initial proposal, Senate Bill 123, calling legislators’ attention to the shortsightedness of repealing a 13-year-old law without first knowing the policies that would take its place.

Though SB 123 passed the Senate Public Health and Welfare Committee, it later stalled in the full Senate.

The new measure, Bruffett said, likely will include stipulations that:

• Allow mental health patients to maintain their current drug regimens if the regimens are known to be successful.
• Limit prior-authorization requirements to “outlier” prescriptions, such as those for toddlers who take more than one or two antipsychotics meant for adults.
• Prevent the KanCare managed care organizations from adopting drug formulary policies until after the formulary framework is approved by KDADS and the Kansas Department of Health and Environment.
• Appoint an advisory committee to help oversee implementation of the new policies.

Bruffett repeated the long-standing concern at KDHE and KDADS that more than 6,500 at-risk children are taking one or more antipsychotics intended for adults.

She also assured the audience that the recent KDADS decision not to renew its prevention grants with five programs, including the Kansas chapter of the National Alliance on Mental Illness and Keys for Networking, was driven by its desire to make more services — and more funding — available to more organizations.

The department’s recent “request for information” on how best to reconfigure the grants prompted input from 21 organizations.

“Our intention is to innovate and integrate mental health prevention with outcome-based programs,” Bruffett said. “We’re doing this to reduce some of our administrative costs and to better leverage our available resources.”

Mark Wiebe, a member of the mental health coalition’s advocacy committee, attended Bruffett’s presentation.

“We appreciate her reaching out to us on these issues and her willingness to include us in the process,” Wiebe said. “If there is, in fact, a need for the reforms that she talked about today, we’ll be participating in that process to make sure that it protects consumers’ access to the medications they need to help in their recovery and toward their being productive members of society.”

Eric Harkness, a licensed pharmacist and a past president of the NAMI group in Topeka, said he suspected the reforms have more to do with the KanCare companies wanting to cut costs than with ensuring patient safety.

“We’ve heard this before: ‘We’ve got all these kids taking antipsychotics, and that can’t be good,’” Harkness said. “I get that, but don’t you have to wonder where all these kids are? I’m sure there are some out there, but if we’ve got way too many kids taking way too many antipsychotics, don’t you think we’d be hearing from their families or whoever it is that’s taking care of them?”

Dr. Ty Porter, a psychiatrist and medical director at Valeo Behavioral Health Care in Topeka, recently joined the work group that’s helping KDADS and KDHE determine how to prevent overprescribing without limiting patients’ access to much-needed drugs.

“I’m new,” he said. “I went to my first meeting last week. But so far, I have to say the focus has been on patient safety and not on costs.”

Porter testified against SB 123 during a Feb. 11 appearance before the Senate Public Health and Welfare Committee.

He also cautioned against reading too much into the managed care organization reports that show thousands of children taking antipsychotic medications.

“The inconvenient truth is that a lot of who we’re talking about here are highly, highly disturbed young children who are born to drug-addicted parents who’ve been subjected to horrific abuse,” Porter said. “I don’t like saying it, but it’s almost like they are feral children, and they can be a danger to other children and to themselves.”

Members of the work group that is helping KDADS and KDHE develop a mental health drug formulary include:

• Dr. Eric Atwood, medical director at Family Service & Guidance Center, Topeka.
• Dr. Michael Leeson, a psychiatrist at Colmery-O’Neil Veterans Affairs Medical Center, Topeka.
• Kyle Kessler, executive director with the Association of Community Mental Health Centers of Kansas, Topeka.
• David Johnson, chief executive at Bert Nash Community Mental Health Center, Lawrence.
• Dr. James Rider, a physician who consults with several nursing homes.
• Jane Adams, executive director, Keys for Networking, Topeka.
• Pete Stern, chief executive with the Kansas Independent Pharmacy Service Corporation, Topeka.
• Dr. Brad Grinage, a psychiatrist at Colmery-O’Neil Veterans Affairs Medical Center, Topeka.
• David Wiebe, president of the Kansas Mental Health Coalition.
• Dr. Ty Porter, medical director at Valeo Behavioral Health Care, Topeka.
• Laura Hopkins, president at Amerigroup Kansas, Overland Park.
• Tim Spilker, plan president at UnitedHealthcare Community Plan, Overland Park.
• Dr. Mike McKinney, chief executive with Sunflower Health Plan, Lenexa.
• Greg Hennen, executive director at Four County Mental Health Center, Independence.
• Jared Holroyd, senior executive director at Atria Senior Living Group, Topeka.

 

Dave Ranney is a reporter for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas.