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January 5, 2017

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

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Francine Sinkoff, Editor

DSRIP Mid-Point Assessment Final Reports/Recommendations

The DSRIP Independent Assessor has completed its review of the PPS response and public comments to the initial recommendations for the Mid-Point Assessment reports and has generated final reports for all 25 PPS. The final Mid-Point Assessment Report for all 25 PPS have been posted to the DSRIP website here .  In addition to the final reports, the IA has also posted a redline version of each report detailing all of the modifications made to each report and the PPS response to the IA's initial recommendations.
In addition to the revisions to the reports for the 25 PPS, the IA has also made revisions to the Companion Document to reflect the changes made to the recommendations for the 25 PPS. The IA has posted both a redline version and final version of the Companion Document along with the compilation of the public comments received by the IA during the initial comment period.
The PPS reports and the Companion Document are posted for a second comment period through January 23, 2017.
All comments regarding the Mid-Point Assessment report should be submitted to
Important Announcement from NYS OASAS:  Scopes of Practice Implementation and Exam Changes

The NYS OASAS Credentialing Unit recently released important changes which became effective on January 1, 2017:
Scopes of Practice
On January 1, 2018, the Substance Use Disorder Counselor Scopes of Practice framework for the OASAS service delivery system will be introduced. Please visit the OASAS website here.   Prior to this date there will be a grandfathering period for the CASAC 2. 
As of January 1, 2017, all existing CASACs have been upgraded to the CASAC Level 2 status.  A new certificate will not be issued, however, the new level will appear on the Credentialing Verification Website here
Also, during the period January 1, 2017 to July 1, 2018, a grandparenting period will be offered for the CASAC Level 2. Individuals who become eligible to receive the CASAC will be grandparented to the CASAC Level 2, regardless of education level. Beginning July 2, 2018, however, individuals will be required to obtain an associate's degree in an approved human services field to receive the CASAC Level 2 or remain as a CASAC (Level 1).

In addition, a grandparenting period for the Advanced Counselor will be offered for the period January 1, 2018 to December 31, 2020. To be eligible, completion of 4000 hours of work experience as a clinical supervisor (gained within 5 years of submission of the renewal application), and 30 hours of Clinical Supervision Foundations I and II training, regardless of education level, will be required. At the conclusion of the grandfathering period, a bachelor's degree and 30 hours of Clinical Supervision Foundations I and II training must be gained to receive the Advanced Counselor.

It is important to note that there will be no grandfathering period for the Master Counselor. Effective January 1, 2018, a master's degree in an approved human services field, completion of 30 hours of Clinical Supervision Foundations I and II training, and 3 years (6000 hours) of qualifying work experience are required to be eligible.

Beginning January 1, 2018, individuals will have an opportunity to apply for the CASAC level for which they are qualified at the time of renewal as follows:  
  • CASAC (Level 1) - GED or High School Level Education
  • CASAC Level 2 - Associate's Degree in a Human Services field
  • Advanced CASAC - Bachelor's Degree and completion of 30 hours of Clinical Supervision Foundations I and II training      
  • Master CASAC Master's Degree in a Human Services field, 6000 hours of Clinical SupervisionWork Experience, and 30 hours of Clinical Supervision Foundations I and II training
The opportunity to apply for a specific scope of practice will only be offered at the time of any renewal occurring on or after January 1, 2018. At that time, a new application will be provided  which details the requirements and instructions to apply for the appropriate scope of practice. 

Exam Changes
Beginning January 1, 2017, the exam retest period will change from once every 60 days to once every 90 days, however, an active application must be on file in order to qualify.  After May 1, 2017, an exam candidate who fails the exam 3 times will be required to take mandatory training to become eligible to retest.
Putnam Family and Community Services Receives 20K Grant 

Putnam Family and Community Services, Inc. (PFCS) has received a $20,000 grant from the Westchester Community Foundation to support its Children's Crisis Response Program.The program serves children and adolescents throughout Putnam County who are facing emergency situations requiring mental health counseling and guidance.

Children and adolescents are facing considerable challenges in a rapidly changing world where social conditions, educational expectations, and current events place more and more stress on them every day. School violence and bullying, rising alcohol, heroin and opioid use, and increases in the number of children who are experiencing anxiety, depression and other mood disorders indicate the need for programs like PFCS' Crisis Response.  Read more here.
How the Disease Model Helps and Hurts Mental Healthcare 

M ental health and addiction  crises  rage on in the U.S., destroying people, families and communities nationwide. Still, the vast majority of those who could benefit from treatment do not receive it. A major barrier to behavioral healthcare access has been financial and the unwillingness of insurance companies to pay for the high costs of treatment for addiction and mental illness.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was enacted in 2008, requiring health insurance companies to cover behavioral healthcare with benefits on par with medical or surgical care. Despite this legislation, many people still do not receive treatment for mental illness and addiction. Those who do receive treatment often have to fight with their insurers or go into crippling debt.

The recent passage of the 21st Century Cures Act will hopefully improve the parity problem by toughening enforcement of parity laws. Read more here.


Rescheduled Children's SPA and HCBS Provider Designation Review Webinar
January 9, 10 - 11 am

January 11, 10 - 11 am

Representatives from NYS OMH, OASAS, DOH, and OCFS will review the designation process and application for providers interested in offering children's State Plan Amendment (SPA) services and Home and Community Based Services (HCBS).   The newly released application can be found here.

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.

January 11, 12 - 1 pm

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 25, 12 - 1 pm

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

Leveraging Your IT Partner For Long-Term Sustainability & Growth with Jim Gargiulo
January 9, 1 - 2 pm, Open Minds

January 10, 1 - 2 pm, Behavioral Healthcare Executive

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



Mental Health Committee
January 9:  11 am - 12:30 pm

RPC Leads & Coordinators Call
January 12:  8 - 9 am 

Chemical Dependency Committee
January 13:  11 am - 12:30 pm

Children & Families Committee
January 17:  11:30 am - 1 pm

Directors & Executive Committee Combined Meeting
January 18:  9:30 am - 12:30 pm

Executive Committee Call (State Budget)
January 24:  9 - 10 am

RPC Leads & Coordinators Call
January 26:  8 - 9 am 

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
Health Insurers Now Required to Cover Treatment for NY Opioid Addicts 

At the start of 2017, health insurance plans will be required to cover treatment services provided to New Yorkers addicted to opioids.

Legislation signed in 2016 by Gov. Andrew Cuomo also calls for increased access to treatment programs and treatment medication, use of a state-approved criteria to determine the level of care needed, expanding community prevention strategies and limiting the over prescribing of opioids in New York.

These new insurance-related protections are the final components of a legislative package that includes measures to remove access barriers for inpatient treatment and medication. It also included several best practices and recommendations identified by the Governor's Heroin and Opioid Task Force.

The insurance coverage requirements apply to small group and large group plans regulated by the Department of Financial Services that are issued or renewed beginning Jan. 1, as well as plans sold to individual consumers.  Read more here.
Governor Cuomo Announces Impact of Potential Affordable Care Act Repeal in New York

Governor Andrew M. Cuomo yesterday announced the impact of potential repeal of the Patient Protection and Affordable Care Act on health care coverage of New Yorkers and the state budget. If the repeal of the Affordable Care Act were enacted, an estimated 2.7 million New Yorkers would lose coverage and New York State would experience a direct state budget impact of $3.7 billion and a loss of nearly $600 million of federal funding that goes directly to counties, which they use to help lower property taxes.

The NY State of Health exchange has successfully cut the percentage of uninsured New Yorkers in half, from 10 percent to 5 percent. It has also significantly expanded eligibility and access to health coverage, allowing hundreds of thousands of previously uninsured New Yorkers to achieve economic and healthcare security. Based on current enrollment levels, the repeal of the Affordable Care Act would result in over 2.7 million New Yorkers losing health coverage. The estimated number of individuals at risk of losing coverage, based on current enrollment levels, is broken down by counties here.

The estimated direct state budget impact of the repeal is $3.7 billion. New York's counties have been able to use the additional federal Medicaid funding through the Affordable Care Act, which goes to directly to counties and helps to lower property taxes. A repeal of the Affordable Care Act would result in a total loss of $595 million in funding. A county by county breakdown of the allocated annual funding that each county would lose is available here, based on the most recent year.
Governor Cuomo Signs Step Therapy Bill

Gov. Andrew Cuomo signed a bill Saturday changing the rules surrounding step therapy, a process by which insurers can require that certain drugs be tried first before approving a physician's prescription.
The bill, which passed unanimously in the state Senate and Assembly, does not ban the use of step therapy, but does provide rules governing how physicians may appeal an insurer's decision and how long an insurer has to answer that appeal.
The new law requires insurers to provide an answer to the appeal within 72 hours, or 24 hours in case of emergency.
The bill was opposed by the New York Health Plan Association, a trade group representing insurers, which worried about vague language in the law that could let physicians declare their preference is in the "best interest of the patient" - a subjective term - and override an insurer's decision.

Tompkins Mobile Crisis Team Unanimously Approved to Offer Mental Health Services 24/7 

For 16 hours a day, people experiencing a mental health crisis in Tompkins County have few options for treatment. Most likely, a person's mental health situation will involve police intervention or hospitalization.

But things are about to change.

On December 20, 2016, the Tompkins County legislature unanimously approved the creation of 24-hour Behavioral Health Mobile Crisis Team, which will operate 24 hours a day, 365 days a year.  The crisis team will be managed by the Tompkins County Mental Health Department.

This means that when people are concerned about the mental well-being of a person, they no longer have to call the police if the situation is not dangerous. Instead, the crisis team can be called to talk to a person experiencing mental health issues face-to-face. This includes incidents sparked by drug or alcohol use.

The Suicide Prevention & Crisis Service will likely become a point of contact for people needing to use the service, though the details of the collaboration haven't been completely hashed out, yet.   Tompkins County 911 dispatchers will also play a major role for the new crisis team.  Read more here.
Additional MRT Regulatory Waiver Requests and Responses

Beginning in March 2015, the Department of Health (DOH), the Office of Mental Health (OMH) and the Office of Alcoholism and Substance Abuse Services (OASAS) have issued regulatory waivers related to an organization's proposed DSRIP projects. DOH, OMH, and OASAS have since issued instruction to PPS for identifying sites where regulatory waivers would apply or other approval is required (i.e. CON, PAR, 3.a.i. threshold application). PPS were required to submit this information via the Regulatory Waiver and Project Tracking tool on November 18, 2016.
At this time, three additional regulatory waiver requests and responses for round two, and four additional regulatory waiver request and responses for round three, have been posted to the DSRIP website here,
Any questions may be sent to
NYS OMH Announces Development of Supportive and Affordable Housing on Staten Island

The New York State Office of Mental Health (OMH) recently announced the release of a Request for Proposals (RFP) to design and build two mixed-use housing projects on Staten Island. The developments will feature both supportive and affordable housing units, with preferential placements given to veterans and Staten Island residents. This RFP is a reissuance of funding formerly allocated to St. Joseph's Medical Center for the development of supportive housing in Staten Island. 

Under the RFP, each development will include 25 units of supportive housing and 25 units of affordable housing for qualified families and individuals. Special priority for both supportive and affordable units will be given to veterans and Staten Island residents.  Read more here .
NPR:  A Peer Recovery Coach Walks The Front Lines Of America's Opioid Epidemic 

Charlie Oen's battle with addiction started when he was 16 and his family moved to Lima, Ohio. It was the last stop in a string of moves his military family made - from Panama to North Carolina, Kentucky, Texas and Germany.

"I went toward a bad group because those were the people that accepted me," he says. Drugs became a substitute for real friendships.

He started drinking, popping pills, cooking meth and shooting heroin. He was homeless for a while when his parents kicked him out of the house. "I would just be wandering the streets of Lima at all hours of the night," he says, "Until I found somewhere, chilled, sat down, fell asleep in an alley."

By age 19, Charlie was serving a three-year sentence in prison on a burglary charge. That's where he stopped using drugs. He spent the last five months of his sentence in a community-based correctional facility where he took classes and completed group work to learn about addiction. The lessons stuck.

"I started telling people, 'I want to be a probation officer,' and everybody knocked it," he says. "They were like, 'You can't do that, you're a felon.' I said, 'Check it out, I'm going to do something.' "

One year later, he started working as a peer recovery coach, using his own experiences to help other people stay in recovery.  Read more here.
Demand for Mental Health Services Soars Amid Provider Shortage

Patients in Chicago who have been identified by their primary care physician as requiring mental health counseling can wait a year or more before they see a specialist, according to Dr. Joanne May, director of Behavioral Health Services at Advocate Illinois Masonic Medical Center.

That's why the state's largest healthcare system recently began embedding behavioral health specialists in its primary care practices. The system's flagship hospital also runs a walk-in mental health clinic open six days a week for patients in crisis. Care is provided on a first-come, first-served basis.

The average wait time at the facility has been reduced to 30 minutes, May said. Patients are getting same-day assessment and treatment.   But Advocate Health Care, which like most systems across the country is grappling with huge unmet mental health needs among its clientele, has run into a major stumbling block. There aren't enough psychiatrists and counselors to meet the burgeoning demand for services.

The shortage is projected to grow acute over the next decade, according to a recent analysis by the U.S. Health Resources & Services Administration. The nation needs to add 10,000 providers to each of seven separate mental healthcare professions by 2025 to meet the expected growth in demand.  Read more here.
Group Proposes Consensus Criteria for "Treatment-Resistant" Psychosis

What does it mean to say a patient with schizophrenia is "treatment resistant"?

Prescribers may recognize treatment resistance when they see it, but there has been no standardized definition.

That's why an international group of more than 50 experts on schizophrenia and treatment resistance this month issued " consensus criteria," which focus on symptom duration and severity, functional impairment, and prior treatment for determining when schizophrenia is treatment resistant.

"This consensus definition of treatment resistance addresses a problem that affects both research and clinical care," Stephen Marder, M.D., one of the members of the Treatment Response and Resistance in Psychosis (TRRIP) working group, told Psychiatric News. "That is, researchers who study treatment resistance have used widely varying criteria for defining clinical populations. This has made it very difficult to compare the results from different studies. The lack of a consensus about the meaning of the term treatment resistance also affects clinicians since it makes it difficult to interpret the relevance of treatment studies to a particular patient."

The TRRIP working group was conceived by Oliver Howes, M.R.C.Psych., of the Imperial College of London, and Christoph Correll, M.D., and John Kane, M.D., of the Zucker Hillside Hospital. "The three of us felt that it was time to develop a consensus around how we should define treatment resistance and publish something that will help investigators develop a common framework for conducting clinical research," Kane told Psychiatric News. "We knew we needed to engage a lot of experts from around the world to develop a true consensus."  Read more here.
Fentanyl Outpaces Heroin as the Deadliest Drug on Long Island

An anesthetic commonly used for surgery has surpassed heroin to become the deadliest drug on Long Island, killing at least 220 people there in 2016, according to medical examiners' records.

The drug, fentanyl, is a synthetic opioid, which can be 100 times more potent than morphine.

The numbers from Long Island are part of a national pattern, as fentanyl fatalities have already surpassed those from heroin in other parts of the country, including New England, as its use has skyrocketed. Part of the reason for the increase is economic - because fentanyl can be manufactured in the lab, it is much cheaper and easier than cultivating heroin.

In New York City, more than 1,000 people are expected to die from drug overdoses this year - the first recorded four-digit death total in city history, according to  statistics compiled by the Department of Health and Mental Hygiene. Nearly half of all unintentional drug overdose deaths in the city since July have involved fentanyl, the health department said.  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.