Policy & Practice

Mental Health Rx Restrictions

Medicare Part D drug plans often employ utilization management techniques, such as prior authorization, for commonly prescribed antidepressants and antipsychotics, according to a report from the Medicare Rights Center. The group, which advocates for Medicare beneficiaries, reported that the use of utilization management strategies varies widely among drug plans, but these approaches are generally used for commonly prescribed drugs and more expensive medications. On average, 23% of antidepressants and 24% of antipsychotics were determined to be either not covered or restricted by utilization management techniques. The Medicare Rights Center called on officials at the Centers for Medicare and Medicaid Services to review all utilization management restrictions to ensure that they are “clinically sound” and are not designed to steer patients to low-cost but medically inappropriate treatments. The group is also pushing for Part D plans that differentiate patients who are beginning a new therapy from those who are stable on a medication at the point of sale. “It is a cruel and devastating hoax to impose insurmountable hurdles between people with mental illnesses and the medicines they need to have decent lives,” Robert M. Hayes, president of the Medicare Rights Center, said. “The CMS should outlaw these barriers to health.” The report analyzed antidepressant and antipsychotic drug coverage across 15 Part D drug plans.

CDC Launches Autism Study

Officials at the Centers for Disease Control and Prevention are launching a multistate study aimed at pinpointing the risk factors for autism spectrum disorders. The $5.9 million study will include about 2,700 children aged 2–5 and their parents. The study will be conducted over 5 years and will look at possible associations with factors such as infections or abnormal responses to infections, genetic factors, the mother's reproductive history, family history of medical and developmental problems, and abnormal hormone function. “We hope this national study will help us learn more about the characteristics of children with [autism spectrum disorders], factors associated with developmental delays, and how genes and the environment may affect child development,” Dr. José F. Cordero, director of the CDC's National Center on Birth Defects and Developmental Disabilities, said.

Medicaid Enrollment, Spending

Spending by the states under the Medicaid program increased 2.8% during the state fiscal year 2006, the smallest increase in about a decade, according to the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. Improvements in the economy and the implementation of the Medicare prescription drug benefit in 2006 may have helped to keep costs lower, according to the results of the 50-state survey released by the Kaiser Family Foundation. There was also an enrollment slowdown in the program with only a 1.6% increase. “When the economy improves, it is natural for Medicaid spending and enrollment growth to subside because fewer people turn to the program for assistance,” Diane Rowland, executive vice president of the Kaiser Family Foundation, said. “But with the continued growth in the uninsured population, Medicaid remains on the front lines for coverage [of] low-income children and adults.”

FCC Changes Children's TV Rules

Officials at the Federal Communications Commission recently clarified the rules regarding requirements for children's television programming. Under the changes, TV broadcasters that have multiple stations must ensure that they air additional children's programming, and only half the shows can be repeats aired in the previous 7 days. The changes also clarify restrictions on the use of Web site addresses in programming. Under the new FCC rules, Internet addresses that do not offer a substantial amount of noncommercial content will be counted against the network's commercial time limits and must be kept separate from its programming. The changes were praised by the American Academy of Child and Adolescent Psychiatry. The new rules revise rules issued by the FCC in 2004 and are based largely on a compromise agreement among the four major broadcast networks, major children's networks, cable operators, advertisers, and a coalition of children's advocacy groups. “Children should have access to educational as well as entertaining television programs. We also need to protect kids from the overinfluence of television advertising, [which] has been linked to childhood obesity and lower academic performance,” said Dr. Michael Brody, chair of the academy's television and media committee.

Medicare Fraud Decision

The two owners of a former San Diego psychiatric hospital have been found liable for more than $23 million in damages and penalties for submitting false claims to the Medicare program. Robert I. Bourseau, Dr. Rudra Sabaratnam, and their corporations, RIB Medical Management Services Inc. and Navatkuda Inc., were charged with billing Medicare for nearly $8 million in costs for a fake lease, unused hospital space, and expenses unrelated to the operation of the hospital. The two individuals, who owned the hospital formerly known as Bayview Hospital & Mental Health Systems, were charged under the federal False Claims Act. “Those who think about cheating Medicare might want to think again,” Carol Lam, U.S. Attorney for the Southern District of California, said. “The defendants here must now pay more than three times what they stole.”