Mark Hurt
14701 Cumberland Road, Suite 105, Noblesville, Indiana 46060
522 Belvedere Drive, Suite 105, Kokomo, Indiana 46901
hurtlawoffice@hotmail.com

Newsletter

MAJOR MOVE IN MENTAL HEALTH REFORM

We should thank the Indiana legislature and Governor Mike Pence for foresight in appropriating 60 million dollars over the next 2 years for treatment and rehabilitation programs for individuals with mental illness and severe abuse addictions. The funds provide targeted resources and treatment that will reduce criminal activity and incarcerations of individuals with co-occurring or mental health disorders.

The goal is treatment, known as forensic diversion, which will reduce the need for hospitalization and optimize personal recovery through trauma-based care, outreach and intensive case management. Higher risk offenders with more needs get more resources with a specific treatment focus. Using evidence based practices, risk and need assessments are conducted through individualized approaches and intensive targeting for behavioral change.

Mental illness is an equal opportunity employer and does not discriminate based on economic status or level of education. You will be surprised to learn how much of your local Sheriff’s budget goes to psychotropic medications. That will soon increase, as Indiana will release nearly 18,000 individuals from the department of corrections and nearly 6,500 Level 5 and 6 felons will now be jailed in local county jails.

The new law, House Enrolled Act (HEA 1006), will work to reduce recidivism through educational and vocational programs, substance abuse treatment and cognitive behavioral therapies. The Indiana Division of Mental Health and Addictions notes that 15% of men and 31% of women in local jails have serious mental illness. Most of these individuals with mental illness are not violent. National research also shows that 53% of prisoners at the department of corrections, 45% of federal prisoners, and 68% of local jail inmates have alcohol and drug additions. This number is 8.8% for the general population.

For medical providers, 10 million dollars is appropriated this year with 20 million dollars next year for forensic treatment, to supplement what Medicaid and insurance does not pay for mental health treatment for criminal defendants.

The new law provides new funding for psychiatrists and other mental health providers to treat criminal defendants with mental health needs. Expanded services include forensic treatment, medication management through home visits with probation officers, transitional housing assistance, supportive employment initiatives, case management, detox, community recovery support programs, and new crisis intervention training for law enforcement. These enhanced mental health services will reduce crime.

The new law trains community corrections officers and probation officers on how to teach offenders to apply for HIP 2.0., so criminal defendants won’t lose Medicaid eligibility when leaving the jail. Funding will also support services for those in the criminal justice system without insurance coverage.

HEA 1006 will assist with a shortage of inpatient beds for criminal defendants with mental illness through the building of a new Central Indiana Hospital that will provide psychiatric services tied to criminal behavioral treatment.

The new law has probation officers, state hospitals, department of corrections, jails, re-entry courts, prosecutors and judges working together in ways these individuals have not worked together before. For that, Governor Mike Pence and the Indiana legislature are to be commended for their significant investment in our criminal justice system and the needs of the mentally ill in Indiana.

• Mark Hurt is an attorney who served as health care advisor to Sen. Dan Coats, R-Indiana, Michigan Gov. John Engler and Rep. Fred Grandy, R-Iowa. Mark has law offices in Kokomo and Noblesville and can be reached at www.markhurtlaw.com

WHAT TO DO ABOUT OUR MENTAL HEALTH PROBLEMS

Some have said there are no Democrats, Republicans or Independents when it comes to mental health. Mental health reform should know no partisanship whether it is treatment for the invisible wounds of soldiers returning from duty overseas or a young child experiencing a psychiatric break due to genetics, trauma or abuse. Today, we need the vision and courage to turn the corner and improve the delivery of mental health and developmental disability services both at home and across the United States. Locally, law enforcement is serving as the provider of last resort. Admittedly, there are no deductibles or co-pays when receiving mental health counseling at a jail or prison at the local or state level. Law enforcement at the local level explain that more placement options are needed than simply in-patient hospitalization and the jail for those who are not receiving proper treatment for their mental illness or developmental disabilities. In short, law enforcement is overwhelmed with the unmet needs and an acute shortage of psychiatric beds, counseling, access to and oversight of medications, and enhanced out-patient mental health treatment.

Psychiatrist and United States Congressman, Tim Murphy, Ph.D., from suburban Philadelphia and Gettysburg, launched oversight investigations into the problems with America’s mental health system last year. Congressman Murphy speaks to a patchwork of laws that are antiquated and uncoordinated. H.R. 3717 seeks to resolve many systemic problems and ensure psychiatric care for those most in need. I encourage you to examine this legislation and contact your federal representatives to support and pass the bill from committee for consideration in both the United States House of Representatives and United States Senate.

Did you know the U.S.A. had 600,000 in-patient psychiatric beds in the 1960s? Today, only 40,000 inpatient psychiatric beds exist for a population over two times the size of 50 years ago. Congressman Murphy’s legislation assists the most critically mentally ill by creating 2 new exemptions to the mental disease exclusion under Medicaid. Just like cancer treatment should not begin after an individual has stage 4 cancer, or diabetes treatment should not begin after an individual has serious ailments, changes in coding/reimbursement rates would work to remedy the shortage of psychiatric beds for locally qualified community mental health centers. Additionally, higher reimbursement rates would work to place mental health treatments on par with other services provided by medical and counseling providers. As is the case with other diseases, early diagnosis and treatment of psychosis improves outcomes dramatically. Prevention does save money and human life, in some cases.

Did you know that only one child psychiatrist exists for every 7,000 children with mental illness or behavior disorders? The reforms in Congressman Murphy’s legislation increases loan repayments and incentives for pediatricians, primary care physicians, psychologists, and psychiatrists to work in underserved areas where patients lack access to mental health professionals. More reforms are needed for incentives to nurse practitioners.

H.R. 3717 promotes alternatives to institutionalization such as assisted outpatient treatment, amends HIPPA regulations so physicians and mental health professionals can share information with parents and caregivers of loved ones (especially in times of an acute mental health crisis); advances medical research of the brain at the National Institutes of Health, re-authorizes and expands mental health courts and evidence based practices for police officers, advances tele-psychiatry by linking pediatricians, psychiatrists, psychologists and primary care clinicians via coordinated care and electronic medical records systems, and strengthens Congressional oversight for review of programs that are not working.

Under H.R. 3717, physicians are granted authority to use a broad array of formularies for Medicaid and Medicare patients. The prescribing of medications would be in line with protected classes of medications for patients with epilepsy and cancer. This is an effort to avoid crisis situations and stabilize patients beyond the emergency room.

In sum, we must deal with reality; this is not an issue of the left or right but rather, an issue of whether our local communities move backward or forward. That is why our community is exploring the idea of community based initiatives for mental health reform such as mental health courts in Indiana, improvements to Medicaid eligibility procedures and coding/reimbursement for providers and crisis intervention training for law enforcement officers and those serving the mentally ill.

Mark Hurt is an attorney who served as health care advisor to Sen. Dan Coats, R-IN, Michigan Gov. John Engler and Rep. Fred Grandy, R-IA. Mark has law offices in Kokomo and Noblesville and can be reached at www.markhurtlaw.com

HEALTH CARE REFORM FOR HARD WORKING AMERICANS

The people of Massachusetts have spoken – will the U.S. Congress listen?

President Obama’s push for comprehensive health reform increases health insurance coverage principally through expanding federally and state funded Medicaid programs. In fact, the two bills in conference committee use a Medicaid expansion to reduce three-fifths (House bill) to four-fifths (Senate bill) of the present uninsured population. Vernon Smith, a principal at Health Management Associates in Lansing Michigan, a former Medicaid Director, notes the recent stimulus package appropriated 87 billion dollars for Medicaid programs in the 50 states over a 2 year and 3 month period of time ranging from October 2008 through December 2010.

After stimulus monies vanish, the House passed health care bill has the federal government paying for costs associated with expanding health insurance coverage to the uninsured for fiscal years 2013 and 2014 but only 91 percent of the costs thereafter. The Senate passed bill pays for new costs of care for expanding coverage to the uninsured from 2014 through 2016 but only 81 to 95 percent of the benefit costs in subsequent years. The levels depend on the state Medicaid matching rate which was highlighted in the infamous cornhusker exemption and Louisiana purchase in recent Senate negotiations.

More Medicaid enrollees means expanded administrative costs for states. Expansion of Medicaid services to the uninsured is projected to raise state-based administrative costs by $9.6 billion for Fiscal Years 2014 through 2019 in the Senate bill and $14 billion between fiscal years 2013 through 2019 in the House passed bill. While a short-term political strategy could be to offer extra transfer payments to quell political opposition, a key question is who pays for these new costs after enactment of the law. Governors and state legislators are genuinely opposed to the bills in conference committee because each bill imposes new costs for state governments and taxpayers at the state level. In Indiana, with current budget shortfalls and a weak economy, one thing Hoosiers do not need is more unfunded federal mandates.

Healthcare reform would be far more effective and affordable if we implement simple insurance reforms that ban insurance companies from dropping individuals with pre existing health conditions and guaranteeing that an individual’s health insurance will not be taken away by disease or sickness in the future. Yes, there are individuals who lose jobs and get sick and employer based care is neither affordable nor available in these situations. Government based coverage should be available in these situations. This will likely require an individual mandate and penalties for those who chose not to pay for health insurance. In line with car insurance, the key issue will be affordability. The insurance reforms are not worth much if the health care policy is unaffordable for those with pre-existing illnesses. Presently, the Senate bill provides no way to assure that the policies will be affordable when these new insurance reforms are implemented. These insurance reforms, combined with subsidies to small businesses enabling small businesses to provide insurance to employees, would solve much of the health care “crisis.”

We need market-based health care reform and true cost containment. The Massachusetts Senatorial election helps us understand more deeply the words of Sam Rayburn, the former speaker of the U.S. House of Representatives, who was known to say, “When I feel the heat, I see the light.” Contact your U.S. Senator and U.S. Congressman and help them see the light.

Mark Hurt is an attorney who served as health care adviser to Rep. Fred Grandy, R-IA, Sen. Dan Coats, R-IN., and Michigan Gov. John Engler. Mark can be reached at www.markhurtlaw.com


WHY DO BUSINESS SUCCESSION PLANNING?

The purpose of this article is to motivate you to think out who will take over your company when you step down or die? Honestly analyze the question, “Can my family work together and really run the business after I am gone?”

Did you know that over 15 million businesses live and breathe in the United States, and nearly 90% of these businesses are family owned or controlled? Nearly 50% of the gross national product and ½ of total wages paid in the United States is produced by family owned businesses, according to the U.S. Small Business Administration.

Only about one 1/3rd of businesses make it to the 2nd generation. Nearly 15% of businesses make it to a 3rd generation.

The overriding problem for many businesses is failing to plan for the future.

Goals in the business succession planning process often include: (1) maintaining family harmony and values, (2) planning to assure continued viability of both business and family and (3) charting strategies to minimize taxes.

I encourage you to make plans today on how to decide your succession plan – your entry and exit strategies – your involvement in your family business after your retirement or after the sale of the business. Think through why buy sell agreements should be funded through insurance to assist shareholders who become disabled, divorced, leave the business, or simply wish to be bought out. Think out whether business earnings can realistically support each family member who works for the business after your death. Decide upon governance issues, compensation and benefit policies for those who will succeed you. For example, should compensation be based on performance or family relationship and should children have voting or non-voting stock when running the business after the death of a patriarch or matriarch?

Any business succession plan must develop a sound strategy to avoid the federal estate tax and inheritance taxes at the state level. Furthermore, family members can decide if an installment payment should be utilized for up to a 14 year payout for estate taxes owing to the federal government. By working in a collective effort with multiple advisors, you decide if your business can be structured to obtain valuation discounts, decide if dividends could be paid to a spouse if the company has never paid a dividend in the past, and at the state level, decide if disclaimers can be utilized within nine months of death to pass down inheritance with the use tax exemptions for children and grandchildren.

Family business succession planning is a collective effort which requires multiple advisors to work together, i.e. your attorney, financial planner, accountant, lending officer and investment advisor. Do not wait too long. Take time today to schedule an appointment and be proactive in passing down your wealth to the next generation.

Mark Hurt is an attorney who practices estate planning, estate and trust administration, and business law. Mark has been a member of the Fishers Chamber of Commerce since 2005. Mark can be reached at (317) 770-0547 and www.markhurtlaw.com.


HEALTH INSURANCE FOR HARDWORKING AMERICANS

For decades the dividing line in the health care debate has been whether health care should be delivered through the government or through the private sector. This issue has been debated and bandied about from the times of Goldwater and Kennedy and the debate lives on today. Two key questions today: Should government-based health care programs serve as a safety net for the nearly 46 million individuals in America who do not have health insurance? And should government-based health care be available for purchase by the working population not covered by employer-based care?

This article focuses on the naive idea that government-provided health care reduces costs. It would appear that President Obama’s push for comprehensive health care reform will actually result in an expansion of Medicaid, Medicare and State Children’s Insurance Programs to a varying degree, thus resulting in increased costs. Meanwhile, it does not appear that Americans want or believe they can afford universal coverage for each individual residing in America.

Interestingly, the number of Americans getting health insurance from Medicaid increased from 38.3 million in 2006 to 39.6 million in 2007 according to Steven Reinberg in a recent article in U.S. News and World Report. The article points out that over the same period, the number of uninsured dropped by about the same number, the first decline in the number of uninsured in 7 years.

The recent stimulus package passed overwhelmingly by the U.S. Congress and signed into law by President Obama appropriated 87 billion dollars for Medicaid programs in all 50 states for a two year and three month period of time ranging from October 2008 through December 2010 according to Vernon Smith, the former Michigan Medicaid Director and a principal at Health Management Associates in Lansing Michigan.

Catherine Hoffman, ScD, a Henry J. Kaiser Family Foundation researcher, states that private health insurance is the primary source of health insurance for approximately 65% of Americans under 65 years of age. She notes the percentage of individuals with private health insurance coverage is dwindling. Also, the states with the highest uninsured rates are those states with the lowest rates of private health insurance coverage. Hoffman states, “Data from the current survey does show the percentage of the nonelderly population that is uninsured is increasing largely because of the decline in employer-sponsored insurance.”

When I served Governor John Engler of Michigan as a Health Care Advisor in the early 1990s, we learned that a large number of the uninsured work full time or part time or are a spouse or child of a person working full time or part time at a business with less than 50 employees. We learned that the working status of the uninsured does not comply with the perception generally held by the public. At that time, data from the population survey showed 62% of the uninsured worked 30 or more hours, 27.4% were unemployed, 9.2% worked 10 to 29 hours per week, and 1.3% worked 1 to 9 hours per week in the state of Michigan.

Nearly two decades later, in a recent Families USA report, “Americans at Risk”, data from the March 2009 Current Population Survey and Medical Expenditure Panel Survey documents that about 79% of those without health insurance in 2007-2008 were from working families, nearly 70% of those defined as uninsured were from families with a worker who was employed full time and 9.5% from families with a worker employed part time.

Another piece of the health care puzzle is that an estimated 12 million illegal immigrants reside in the United States – that is at least 2 times the number of people living in the state of Indiana. While illegal immigrants are not eligible for coverage through Medicaid or public benefits, immigrants can access health care through federally qualified community health centers. Studies show that 15% to 22% of the uninsured in America are illegal immigrants.

California is spending over 1 billion dollars for coverage for illegal immigrants who have no health insurance. A Florida Hospital Association survey of 28 hospitals found health care for illegal aliens exceeded $40 million. In states like Arizona and Texas, the costs are high. The Texas comptroller estimates the cost of health care for illegal immigrants was $1.3 billion in 2006. The stakes of the health care reform are steep.

Did you know that a large share of uninsured Americans are age 18-24, feel healthy and do not want to spend money on health care insurance? These younger Americans roll the dice and go without health insurance. When they do get sick or have an accident, we all pay for it through higher costs at the hospital and higher premiums on our insurance. It’s what California Governor Schwarzenegger calls “the hidden tax.” Do we mandate that these elements of the population have to get health care insurance? Who pays for it?

Persistently rising health care costs are why many employers are dropping coverage, lessening coverage or simply not offering workers health insurance coverage. Rising health care costs heighten the plight of the uninsured. Health care costs will be addressed in my next article.

Mark Hurt is an attorney in north central Indiana who served as Health Care Advisor to Congressman Fred Grandy (R-IA), U.S. Senator Dan Coats (R-IN) and Governor John Engler (R-MI). Mark Hurt can be reached at www.markhurtlaw.com .


HOW MUCH WILL THIS COST?

Just like cap and trade, the health care discussion is turning into a debate on economics and costs. The legislation on the floor of the Senate takes in tax revenues from 2010-2014 but postpones spending until after 2014. Senator Judd Gregg calls this a shell game. Unlike the House passed bill, the Senate bill includes an increase in the Medicare portion of the payroll tax. The current Medicare tax is 2.9 percent and it is paid equally by employers and employees. Under the Senate bill, the Medicare payroll tax rises to 3.4 percent for workers making more than $200,000 a year and joint tax filers with annual income over $250,000.

Rea Hederman and Curtis Dubay, Senior Policy Analysts at the Heritage Foundation, note that the House passed bill includes:

  1. 5.4% surtax on joint filers with adjusted gross income over $1 million or single tax filers whose agi exceeds $ 500,000.00 (Estimated to raise $460 billion.)
  2. an excise tax of 2.5% on the sale of medical devices ranging from wheelchairs, breast pumps, insulin injectors and syringes for patients with diabetes ($20 billion)
  3. 8% tax on total payroll for businesses with over $750,000.00 in total payroll;
  4. limits on flexible spending accounts ($13.3 billion savings)
  5. exclusions for over the counter drugs – can not be paid for by health savings accounts
  6. eliminating deductions for expenses which are allocated to the Medicare Part D subsidy program ($3 billion savings).

And the list goes on, from an excise tax on high cost “Cadillac” health insurance plans that cost more that $8,500 a year for individuals or $21,000 for families, limiting qualified medical expense definitions and the creation of a 5% tax on cosmetic surgery and procedures like Botox treatments, tummy tucks and face lifts. A lot of taxes but not much cost containment. Interestingly, the taxpayer will be asked to pay more and more taxes if a government based health care plan is allowed to subsidize itself in the future.

A recent health care forum hosted by the Fishers Chamber of Commerce saw providers, employers and consultants prescribing medicine to cure our present system. Panelists noted that true reductions in cost and improved efficiency can only be obtained through better management of chronic disease, sharing of medical information through electronic medical records across provider and state lines, changes in the way medical providers are compensated, elimination of perverse reimbursement formulas for health care providers, and medical liability reform. No where in any of the nearly 2,000 pages of the House or Senate bill do we see wellness programs or ideas which change our culture or which allow for enhanced personal accountability. One example cited by a panelist at this health care forum is helping the senior citizen who should be fitted for the right type of sock and shoe when circulation and diabetic issues are at hand.

We need a new focus on primary care. We need non-physicians helping patients with nutritional counseling, with preventions for diabetes and with heart disease. We need doctors who are paid the same for each patient and who share and profit from savings in the health care system through use of best practices which are rooted in outcomes research and use of evidence based practices.

Healthcare reform would be more effective and affordable if we implement simple insurance reforms that ban insurance companies from dropping individuals with pre existing health conditions and guaranteeing that an individual’s health insurance will not be taken away by disease or sickness in the future? This will require an individual mandate and penalties for those who chose not to pay for health insurance. In line with car insurance, the key issue will be affordability. The insurance reforms are not worth much if the health care policy is unaffordable to those with pre existing illnesses. Presently, the Senate bill provides no way to assure that the policies will be affordable when these new insurance reforms are implemented.

We should focus subsidies on the small businesses with less than 50 employees since most uninsured work full time or part time at these small businesses or are the spouse or child of a worker at a small business that does not have the profit margins to pay for health insurance. Furthermore, instead of a public option, instead of taxpayer support of abortion, instead of government based rationing, instead of taxes on medical devices, instead of increased Medicare premiums, and instead of unrealistic cuts in Medicaid and Medicare reimbursements to providers, simple insurance reform with subsidies to individuals at small businesses would accomplish the reform most Americans are wanting.

When the final two versions of health care reform move to conference committee for the ironing out of differences between the House and the Senate passed bills, our representatives do not have to vote for the bill. The legislation, in their present forms, should be rejected. We need market-based health care reform. Sam Rayburn, the former speaker of the U.S. House of Representatives was known to say, “When I feel the heat, I see the light.” Contact your U.S. Senator and U.S. Congressman and help them see the light.

Mark Hurt is a Kokomo attorney who served as health care adviser to Rep. Fred Grandy, R-Iowa, Sen. Dan Coats, R-Ind., and Michigan Gov. John Engler.


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