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Without Nieland, Mental Health Group gets to work

Newton Daily News - 9/20/2018

Sept. 20--With or without Dan Nieland, the Jasper County'sMental Health Collaborative Group didn't waste an opportunity to get down to business Wednesday afternoon.

Nieland, the Democratic candidate for Senate District 15 called the forum together last week to learn more about the group's mission in Jasper County.

With the Sept. 14 announcement that a federal grand jury has charged 47-year-old Leesa Marie Parkhill-Nieland, Nieland's wife, with Social Security fraud, the Polk County candidate announced he wouldn't be participating in the forum. In a telephone interview with the Newton Daily News Monday morning, Nieland said he's withdrawing from the forum in order to "focus on other things."

"That's just it. I've got other things to focus on at the moment," Nieland said. "I hate to be distraction to something that's very important like this."

With Nieland out, State Rep. Wes Breckenridge, D-Newton, took the lead Wednesday afternoon, quizzing local mental health advocates in Jasper County to learn more about the legislature can take action to improve mental health care for Jasper County residents.

Breckenridge, who has made improving mental health care a focus of his legislative efforts, said he is looking forward to continuing to work the group. While House File 2456, signed into law earlier this year by Iowa Gov. Kim Reynolds, creates sweeping changes to the state's mental health treatment system. Breckenridge said plenty of work remains to be done, including securing a sustainable funding source for the new legislation.

The broad scope of the bill will create changes across the board, including the creation of six community-based mental health centers across the state. It also addresses dealing with commitments, licensing of subacute mental health facilities, disclosure of mental health issues to law enforcement, video conferencing of hospitalization hearings, transportation service contracts, mental health and disability services quarterly reports, regional core services, reduction of fund balances from mental health regions, commitment process report and a tertiary care psychiatric hospitals report.

"There's some good components with this piece of legislation, but we need to identify the things we need to follow up with and make sure they get done," Breckenridge said.

First on Central Iowa Community Services CEO Jody Eaton's list -- getting rid of Senate File 504. In April, the Senate voted 46-4 to move forward with the legislation, which was designed to allow counties more flexibility in managing mental health costs while avoiding raising property taxes, which are used to fund those services. All four "no" votes were from Polk County Democrats, where the county's mental health funding typically spends $7 million more than it takes in every year. The proposal, which would require regions to spend down fund balances doesn't work, Eaton said. The legislation would ultimately force Eaton to cut providers as the state seeks to offset taxes.

"The thing is, I honestly don't feel good about thinking I just have to spend this money so I can get the fund balance and put my providers at risk," Eaton said. "We need to get rid of that requirement."

In 2013, the state of Iowa re-organized counties into 13 separate regions, which combined their property tax revenues. Doing so created inequities between counties, some of which are under a 1996 cap, which keeps them from having a identical tax rate to other counties in their region. Eaton said she's in favor of removing the cap altogether.

"They equalized the levy within each region. They either need to totally remove the caps and just let us do what we need to do," Eaton said. "We'll have to decrease funding by 2022."

With representatives from most of the counties primary mental health services in attendance, advocates had a chance to personally lobby Breckenridge for changes they see as critical to keep improvements to the state's mental health system moving forward. Judy Bishop-Gibson, CHI Grant Coordinator for Skiff Medical Center, said she would like to see legislators look at making it easier for students to receive therapy at their schools. Transporting students off campus reduces the number of contact hours students in therapy have each day, it increases the risk of the student not graduating.

"The schools would really like to see more therapy happen in the schools, because of the loss of education time that happens while the child is being transported, and that's difficult for providers," Gibson-Brown said. "Most of these students, they are much more at risk for not graduating high school if they miss this much contact time."

Julie Smith, the Center Director at Capstone Behavioral Center in Newton, said she is still struggling to help patients within the Medicaid system. With Medicaid patients often waiting up to 60 days for prescription changes to take effect, Smith and staff members at Capstone have turned to SafeNetRX, a company that provides free samples of prescription drugs that have been turned in. Staff members are able to hand out those samples to patients, who would otherwise be forced to wait for two months.

"They'll send it out, because sometimes it takes up to 60 days to get a prior authorization done with Medicaid, and that's ridiculous," Smith said. "We're lucky that we're able to access those samples, but that's a lot of extra work for my nurses. They have to help with prior authorizations because it's such a struggle."

When Breckenridge asked Smith how the process could be streamlined, Smith said she believes the private insurance companies who are responsible for Medicaid patients are pushing back against the recommendations her staff makes.

"The MCO's need to respect the fact that the doctor is the professional, they're the ones who are prescribing the medications," Smith said.

This isn't the first time the state's Medicaid program has come under fire. Iowa's Medicaid program, which was privatized in 2016, has been under added scrutiny since last November when one of the three insurance companies overseeing the system dropped coverage. The managed care organization (MCO) AmeriHealth failed negotiations with the state over money. Since then, the Iowa Department of Human Services announced there would be limited choice temporarily for patients between the remaining two companies.

The $5 billion program, which is funded through a combination of federal and state funds, serves more than 600,000 people. Legislators have inundated with complaints about the system, with lawmakers on both sides of the aisle agreeing the privatized system isn't working, something Reynolds admitted.

"We have made mistakes, the rollout was not perfect, but it is the right thing to do," Reynolds said earlier this year. "But we have to recognize and admit the mistakes we made and we have to look at ways to move forward."

The issue has taken center stage in the governor's race, with Reynolds squaring off against Democrat Fred Hubbell, who has said he will reverse the privatization of Medicaid if he was elected governor. For rank and file lawmakers like Breckenridge, a member of the minority party, it's more about finding ways to make tweaks to the system to increase the quality of care for Iowans.

"This is an ongoing thing we have to stay on top of," Breckenridge said. "If there's things that we can jot down, that we can kind of make headway on, that's kind of our goal here."

Contact David Dolmage at 641-792-3121 ext. 6532 or ddolmage@newtondailynews.com

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(c)2018 the Newton Daily News (Newton, Iowa)

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