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December 21, 2016

Advancing Public Policies for People with Mental Illness, Chemical Dependency or Developmental Disabilities   

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Francine Sinkoff, Editor

IDD CAG Public Comment

The Intellectually/Developmentally Disabled Advisory Group has produced the Value Based Payment Arrangements for Adults with Intellectual or Developmental Disabilities (IDD) interim progress report.
This advisory group report has been posted for public comment on the DSRIP Website here.   The public comment period will begin on December 20, 2016 and will end on January 20, 2017.
The advisory group reports provide definition  and associated quality measures for each VBP arrangement.  The advisory group reports inform providers and payers of the details of each arrangement, further supporting their transition to VBP.  The IDD Interim Progress Report is not a final report from the IDD Advisory Group. The report is intended to provide a review of efforts underway that are related to this important topic. Public comments will be collected and used to inform further deliberations on VBP arrangements.
Please submit any written comments by January 20th to
Jail Suicides Are Largely Preventable. So Why Are They On The Rise?

More people committed suicide in jail in 2014 than in any other year since at least the turn of the century, according to newly published federal statistics.

One thousand fifty-three people died in local jails in 2014, according to a report  released
by the Justice Department's Bureau of Justice Statistics this week. That's an 8 percent jump in the number of jail deaths from 2013 to 2014, and the largest number of jail deaths counted since 2007. The jail death rate, 140 deaths for every 100,000 inmates, was also the highest it has been since 2007. 

Even more alarming is the rise in the number of suicides - which, as The Huffington Post  reported in July, are largely preventable. There were 372 jail suicides in 2014, an average of more than one per day. That's a 13 percent jump from 2013.   Read more here .
Medicaid Managed Care - Dominant Where It Exists

Here is a market picture for you to consider.
Medicaid is the largest source of public health coverage in the United States - about 75 million Americans are enrolled in Medicaid. In addition, 68.8% of the Medicaid beneficiaries across the country have their health benefits provided through managed care plans - up from 60.5% in 2014 (see  68.8% Is The National Number - What Is Your State Number?).

Now consider that as of October 2016, in 28 of the 39 states that contract with Medicaid managed care organizations (MCOs), at least 75% of all Medicaid beneficiaries were enrolled in those MCOs (see  In 28 States With Medicaid Managed Care, At Least 75% Of Beneficiaries Are Enrolled).

This capture of market share by Medicaid health plans has some very specific implications for managers in provider organizations. Essentially, once the decision is made at state policy level to move the Medicaid population to some form of health plan, little remains of the market outside of the health plans. In those states, maintaining a "non-managed-care" Medicaid service line will be difficult.  Read more here.
Medicaid Savings Require Integrated Physical, Mental Healthcare

Integrated population health management strategies are foundational for cutting costs and improving outcomes for Medicaid beneficiaries with complex behavioral, clinical, and mental healthcare needs, the Anthem Public Policy Institute states in a  new report .

Managed care organizations (MCOs) that successfully break down siloes between behavioral and clinical care environments may be the key to delivering coordinated, cost-effective, and  comprehensive services to vulnerable populations facing a range of socioeconomic challenges.

"Too often, owing to the typically siloed nature of health care services and payment for physical health and mental health/substance abuse treatment, these conditions have been treated apart from one another, leading to poorer outcomes and higher costs,"  said Jennifer Kowalski, vice president of the Anthem Public Policy Institute.

"MCOs are uniquely positioned to support the delivery of integrated, holistic care. MCOs can serve as the locus of coordinated care for beneficiaries by working with state Medicaid programs, mental health agencies, providers, members and their families, as well as community-based organizations that coordinate housing and other needs."

The case for  integrating mental and physical healthcare is a strong one, says the report, and the financial argument is becoming increasingly clear.  One in five Medicaid beneficiaries has a mental health or substance abuse issue, and sixty percent of those patients have also been diagnosed with at least one chronic disease.  Read more here.
Homeless Across Country Fall Victim to Synthetic Marijuana

The nation's homeless are proving to be especially susceptible to a new, dirt-cheap version of synthetic marijuana, which leaves users glassy-eyed, aimless, sprawled on streets and sidewalks oblivious to their surroundings or wandering into traffic.

The homeless are easy targets in a confined area, experts say. The drug is cheap - as little as $1 or $2 for a joint - more difficult to detect in drug tests and is a fast escape from a harsh reality.

Synthetic marijuana has been around since the late 2000s, packaged under names like K2, Darkness and Mr. Happy. The Drug Enforcement Administration says it is usually a mixture of herbs and spices sprayed with a synthetic compound chemically similar to THC, the psychoactive ingredients in marijuana. It is typically manufactured in China and sold in places like head shops, but it's also on the street and over the internet.

State legislatures have outlawed it based on its chemical makeup, but the makers tweak the formula enough that it escapes the provisions of the law. So far in St. Louis, only one charge has been filed - a homeless man accused of selling to others on the street.  Read more here.



CTAC is offering a 6-part webinar series on the broad principles and core competencies of documentation for direct service providers and supervisors. 

January 9, 1 - 2 pm

MCTAC will host a one-hour state-led webinar regarding Non-Medical Transportation. The DOH Transportation Unit will present on roles and process, review allowable vs non-allowable trips, and include time for discussion/Q&A.

Understanding the Electronic Billing Claim Cycle
January 18, 3 - 4 pm

This webinar is for the education of entry level electronic billing. This webinar will explain the basic steps for electronic billing. This is not a webinar to explain how to specifically send claims for HCBS service as that is a more detailed and advanced course.  

January 5, 3:30 - 4:30 pm, SAMHSA-HRSA Center for Integrated Health Solutions

January 10, 1 - 2 pm, Behavioral Healthcare Executive

January 17, 1 - 2:30 pm, The Commonwealth Fund



Office Closed - Christmas
December 26


Office Closed - New Year's Day
January 2

Officers, Chairs & Regional Reps Call
January 4:  8 - 9 am

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
Regional Planning Consortium Update:  Western NY

Pictured Above, Orleans County DCS Mark O'Brien reviews the basics about Regional Planning Consortiums (RPCs) with the crowd. This meeting took place in Buffalo on 12/14/16. The attendees also were able to see the current slate of nominees for the Western Region RPC board. Much thanks goes out to the Western Region DCS's and Western Region RPC Coordinator Margaret Varga for their effort in organizing this meeting.   To learn more about the RPC in your region please visit:
HHS Selects New York for a Two-Year Behavioral Health Program

The Department of Health and Human Services announced Wednesday that New York and seven other states have been selected to participate in a two-year Certified Community Behavioral Health Clinic demonstration program.
The program will provide integrated services, such as cognitive behavioral therapy, counseling and services related to "supporting employment goals," medication-assisted treatment for substance abuse and integrated treatment for co-occurring disorders.
New York's demonstration program has certified 13 clinics.
"New York and its community clinics have done an incredible job in paving the way for the demonstration program," said Kana Enomoto, deputy assistant secretary for mental health and substance use. "We look forward to demonstrating that by balancing incentives and accountability, an enhanced level of accessible, comprehensive and quality care can be provided to all Americans."
The state's program, according to a release from HHS, will use a daily prospective payment system, meaning that Centers for Medicare and Medicaid Services will reimburse the participating CCBHCs at a fixed daily rate for services to those on Medicaid.  Read more here.
Release of Provider Designation Application and Guide for the Proposed Children's SPA/HCBS

The New York State (NYS) agencies including the Department of Health (DOH), Office of Alcoholism and Substance Abuse Services (OASAS), Office of Children and Family Services (OCFS) and Office of Mental Health (OMH) are pleased to announce the release of the Children´s State Plan (SPA)/Home and Community Based Services (HCBS) Provider Designation Application.
The State expects to seek approvals from the Centers for Medicare and Medicaid (CMS) of an 1115 Waiver and State Plan Amendments (SPAs), which collectively will implement the Medicaid Redesign Team (MRT) Children´s Behavioral Health and Health Medicaid Redesign Plan. The approvals of those collective documents will authorize the State to implement the proposed six new State Plan services and the HCBS. Providers that choose to submit an application to become a designated provider of the proposed six new SPA services and/or HCBS as described in the Application and Guide are advised that such designation and ability to provide services under such designation is contingent upon the State receiving CMS and any other approvals required for implementation of such Medicaid services.
The Children´s SPA and/or HCBS Provider Designation is a multi-State agency process which grants designated and authorized providers eligibility to be reimbursed under Medicaid for the provision of SPA and/or HCBS. The designation application will be available here.  New York State (NYS) providers who wish to apply for designation must have an established user ID and Facility Code. The user ID, granted through the NYS Office of Mental Health (OMH), will enable the electronic application to be accessed and completed. If a provider does not have/is not aware of whether they have an OMH User ID and Facility Code, instructions on obtaining these credentials are available here.
Providers requesting designation within the initial roll out period of this application will be required to submit a completed application by Wednesday, February 1, 2017. Given the timeline for implementing the six new SPA services and HCBS, NYS will prioritize review for those providers seeking designation in Other Licensed Practitioner (OLP). Initial designation for OLP will only be based on the provider´s current operating certificate for this initial, priority review. Designation reviews for other requested SPA/HCBS will be following the initial roll out period.
Obtaining an OMH User ID and Facility Code to access the Children's SPA/HCBS Designation Application.
Questions can be directed to:
Governor Cuomo Announces $1.75 Million for Five New Centers to Help Those in Recovery From Addiction

Governor Andrew M. Cuomo last week announced $1.75 million in funding to support five new Recovery Community and Outreach Centers in communities in Central New York, the Southern Tier, and New York City. This addition brings the total number of recovery centers in the state up to 14, with one in every state economic development zone and in each of the five boroughs of New York City. The new centers will provide health, wellness and other critical support to individuals and families who are recovering from a substance use disorder or are seeking recovery services for a family member or friend. 

These model recovery centers are a key piece of Governor's aggressive, multi-pronged approach to addressing substance use disorders in New York State. The Governor's Heroin Task Force, launched in May of 2016, heard from New Yorkers throughout the state about the importance of ongoing, locally-based recovery services. These five new centers will respond directly to that need. 

The five centers are in addition to the six centers Governor Cuomo  announced  in June 2016 and three already operational New York State Office of Alcoholism and Substance Abuse Services-funded recovery centers in  Oneonta Rochester , and  Brooklyn . The centers will engage peers and volunteers to assist those in recovery on their path toward wellness. Center staff will provide resources and host activities that foster a lifetime of wellness for individuals, families and community members.  Read more here .
Why are Americans with Severe Mental Illness Dying 25 Years Younger than their Peers?

When Ken Jue was the director of a community mental-health center in New Hampshire, he felt it was his obligation to attend the funerals of clients who had died. And he was attending a  lot  of  funerals .

Jue began investigating the trend and found grim statistics. Americans with severe mental illness die on average  25 years younger  than their peers, not from suicide or drug abuse, but from preventable physical ailments like smoking and obesity.  "This really is the largest recognized health disparity in the United States," said Dr. Stephen Bartels, a professor of psychiatry at The Dartmouth Institute. "A tragic part of the stigmatization of mental illness is the marginalization of these individuals."

For people with severe mental illness, maintaining physical health can seem impossible. The obstacles that prevent anyone from eating well and exercising are multiplied for this vulnerable population. "In our research group, we refer to it as the perfect storm," Bartels said.  

People with severe mental illness, including bipolar disorder and schizophrenia, suffer from diseases that make it difficult to find motivation. In addition, many drugs used to treat psychosis cause weight gain and make it impossible to feel full after eating. These challenges are compounded by the fact that many people with severe mental illness live in poverty, which makes access to healthy food and a safe space to exercise limited.
"All these things conspire to reduce the life expectancy," Bartels said.   Read more here.
Opioid Epidemic is Getting Worse, Says CDC

The number of deaths from overdoses of illicit opioids rose sharply again in 2015, the Centers for Disease Control and Prevention announced Thursday.

"The epidemic of deaths involving opioids continues to worsen," said CDC Director Dr. Tom Frieden said. "Prescription opioid misuse and use of heroin and illicitly manufactured fentanyl are intertwined and deeply troubling problems."

Overdose deaths (9,580) from synthetic opioids, most of them fentanyl related, skyrocketed by 73%. Deaths that involved prescription opioids (17,536) rose just 4%.

And deaths attributed to heroin (12,990) went up 23% in 2015.  Read more here.
'Drug Dealer, M.D.': Misunderstandings And Good Intentions Fueled Opioid Epidemic

America's attitude toward pain has shifted radically over the past century. Psychiatrist Anna Lembke says that 100 years ago, the medical community thought that pain made patients stronger.

But as prescription painkillers became more available, patients became less willing to endure pain. Suddenly, Lembke says, "doctors began to feel that pain was something they had to eliminate at all cost."
Prescriptions for opioid painkillers increased, and so, too, did cases of opioid addiction. In 2011, the Centers for Disease Control and Prevention declared a prescription drug epidemic as a result of doctors overprescribing painkillers to patients. Lembke's new book, Drug Dealer, MD, explores the origins of the prescription drug epidemic from a doctor's perspective.
Read more here.
The Conference of Local Mental Hygiene Directors advances public policies and awareness for people with mental illness, chemical dependency and developmental disabilities.  We are a statewide membership organization that consists of the Commissioner/ Director of each of the state's 57 county mental hygiene departments and the mental hygiene department of the City of New York.