Medicaid Changes Could Cripple Community Mental Health

Just received this email alert from the Bazelon Center for Mental Health Law.

Comments Needed on Revised Medicaid Rules
Changes Could Cripple Community Mental Health

August 20, 2007--Changes in the rules proposed by the Centers for Medicare and Medicaid (CMS) to govern Medicaid’s rehabilitation service category could restrict access to intensive community mental health services needed by children and adults with disabilities who rely on Medicaid for their healthcare. (See the Bazelon Center’s August 16th Information Alert.) The proposed regulations were published in the Federal Register on August 13, 2007 (Vol. 72, No. 155, 45201-45213).

As the single most significant source of financing for the public mental health system, Medicaid provides needed access to community-based care through the rehabilitative services option to help children and adults avoid institutionalization. The new rules could also have a profound effect on Medicaid services needed by other vulnerable populations, including people with physical and developmental disabilities.
Stakeholders’ Comments Can Make a Difference

If final regulations as later promulgated include many of the proposed changes, they will have a devastating affect on the availability of vital services, potentially crippling the community mental health service delivery system. A high volume of comments is often influential, so it is vital that CMS hear from large numbers of consumers, advocates, providers and other stakeholders about the threats posed by the proposed rules.
What You Can Do
Send your comments to CMS by the October 12, 2007 deadline. This is a critical opportunity to call upon CMS to make changes in a number of key areas and to influence the final rules. All public comments will be considered.

See sample comments and details on how to submit yours in the full text of this Action Alert at http://www.bazelon.org/takeaction/2007/RehabRules9-20-07.htm.

A Positive Place

I woke up this morning, still under the weather with a minor flu that's kept me down for a day and a half, but finally with some creativity and motivation. These days my cycling comes around to give me ideas and energy way too infrequently. I'm excited, and hope to get caught up on blog posts, BipolarConnect shareposts, and making the rounds of other's blogs. I may even get a chapter or two written.

I love it when this frame-of-mind rolls around.

Supplement Questions

Hey All – looking for some input here. I had a cold hit me Saturday, and I’ve been miserable since then. It feels like some flu is at work also. I went out over lunch and picked up some vitamin C and zinc, but I’m not sure about the right dosages. The C I’m thinking 500 mg every 2 hours, and the zinc 50 mg every 2 hours. For those “in the know” about supplements, I’d appreciate your input.

Also, on my last pdoc visit, the doc told me about chromium. How it can help glucose metabolism, cholesterol metabolism, aid in weight loss, and so forth. Has anyone used this before? I just started taking 200 mg a day, and wondering if that’s a good dosage.

Diet Supplements and Safety: Some Disquieting Data

From The New York Times:

Diet Supplements and Safety: Some Disquieting Data

Since 1983, the American Association of Poison Control Centers has kept statistics on reports of poisonings for every type of substance, including dietary supplements. That first year, there were 14,006 reports related to the use of vitamins, minerals, essential oils — which are not classified as a dietary supplement but are widely sold in supplement stores for a variety of uses — and homeopathic remedies. Herbs were not categorized that year, because they were rarely used then.

By 2005, the number had grown ninefold: 125,595 incidents were reported related to vitamins, minerals, essential oils, herbs and other supplements. In all, over the 23-year span, the association — a national organization of state and local poison centers — has received more than 1.6 million reports of adverse reactions to such products, including 251,799 that were serious enough to require hospitalization. From 1983 to 2004 there were 230 reported deaths from supplements, with the yearly numbers rising from 4 in 1994, the year the supplement bill passed, to a record 27 in 2005.

The number of deaths may be far higher. In April 2004, the Food and Drug Administration said it had received 260 reports of deaths associated with herbs and other nonvitamin, nonmineral supplements since 1989. But an unpublished study prepared in 2000 for the agency by Dr. Alexander M. Walker, then the chairman of epidemiology at the Harvard School of Public Health, concluded: “A best estimate is that less than 1 percent of serious adverse events caused by dietary supplements is reported to the F.D.A. The true proportion may well be smaller by an order of magnitude or more.”

But most other types of herbs and specialty supplements also appear in the annual report. In 2005, the poison centers received 203 reports of adverse reactions to St. John’s wort, including 79 hospitalizations and 1 death. Glucosamine, with or without chondroitin, was linked to 813 adverse reactions, including 108 hospitalizations and 1 death. Echinacea was linked to 483 adverse reactions, including 55 hospitalizations, 1 of them considered life-threatening. Saw palmetto was not listed on the report.

Note that St. John's Wort is on the list, it's a popular supplement for depression.

This isn't an indictment of herbal meds, it's just a heads-up.

Let's be careful out there.