Legislators voice concerns about proposed authorization process for prescriptions
by Dave Ranney
The Senate Public Health and Welfare Committee on Wednesday passed a bill that would allow KanCare, the state’s privatized Medicaid program, to regulate mental health patients’ access to antipsychotic medications.
Although the measure, Senate Bill 123, passed on a 6-3 vote, two of its backers — Republican Sens. Mitch Holmes of St. John and Jim Denning of Overland Park — said their support was “cautious” due to the committee’s uncertainty about how the Kansas Department of Health and Environment intended to regulate the prescription processes.
“Preauthorization, that’s really the hang-up that I have,” Denning said, noting that he was uncomfortable with the prospects of someone with a mental illness being denied immediate access to medication they’d been prescribed or had come to depend on.
Denning said he’d heard that if the bill becomes law, KDHE might enact a three- or five-day “automatic refill” policy to ensure patients’ access to their medications while their physicians, pharmacists and managed care companies resolve prescription authorization issues.
“That makes my comfort level slightly better,” he said, adding that he expected KDHE to provide committee members with copies of the proposed policies before the bill is debated by the Senate.
The two Democrats on the nine-member committee, Sen. David Haley, D-4th Dist., and Sen. Laura Kelly of Topeka, voted against the bill.
“I’m opposed,” Kelly said. “I think we need to give this more time. I was hoping we could put this off until there’d actually been an opportunity for (KDHE) to do more than what’s been accomplished so far.”
Sen. Elaine Bowers, a Republican from Concordia, also voted no. “I’d rather we fix (SB 123) in here than on the Senate floor,” she said, adding that the community mental health center in her district had urged her not to support the legislation.
“I respect my experts back home,” Bowers said.
The state’s mental health advocates oppose the bill, warning legislators that it would add administrative barriers to a treatment system that’s already challenging to navigate, send some high-risk patients into crises and shift a sizable portion of the system’s costs onto hospitals and jails.
Since 2002, state law has guaranteed Medicaid patients’ access to whatever behavioral health drugs their physician or psychiatrist sees fit to prescribe.
SB 123 would rescind the guarantee and allow KDHE to decide how, after July 1, the managed care companies would be allowed to regulate patients’ access to mental health drugs.
“We look forward to there being continued dialogue on this and we continue to oppose repeal of the current law,” said Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas.
KDHE Acting Secretary Susan Mosier has assured legislators that the new prescription processes would improve beneficiaries’ health and likely save the state $8.3 million.
State officials, led by Department for Aging and Disability Services Secretary Kari Bruffett, on Tuesday met privately with KDADS and KDHE officials, managed care organization representatives and mental health providers to discuss policy development.
The providers were represented by Kessler; Dr. Eric Atwood, a child psychiatrist with the Family Services and Guidance Center of Topeka; and Jane Adams, executive director at Keys for Networking, a program that counsels families with children with serious emotional disturbances.
Denning said he’d let KDHE know that he expected the providers to have a meaningful role in the crafting of the regulations.
After Wednesday’s hearing, KDHE Assistant Secretary Aaron Dunkel said the department is intent on making sure the “the appropriate ‘guardrails’ are in place,” and that “the things that are being feared don’t happen.”
The “driving issue,” he said “are the safety issues, especially around the young and the elderly” rather than reducing the program’s costs.
KDHE officials have long expressed alarm over data that show that hundreds of young children in Kansas are taking one or more antipsychotics intended for adults.
Advocates for better nursing home care say antipsychotic drugs are too often used to control residents whose dementia makes them challenging to manage.
Dunkel said the department hopes to have a rough draft of the would-be regulations available prior to SB 123 hearings in the Senate, which are not yet scheduled.
KDHE, he said, has assured legislators that if SB 123 were to become law, the KanCare companies would be prohibited from altering any mental health patient’s drug regimen until after the department completed its regulations.
Bills introduced in the Senate are expected to pass the chamber by Feb. 27 before being referred to the House.
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