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August 3, 2016

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

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Francine Sinkoff, Editor

Save the Date: Behavioral Health Value Based Payment Conference

The New York State Office of Mental Health and Office of Alcoholism and Substance Abuse Services, along with the Health Foundation for Western and Central New York and the Managed Care Technical Assistance Center will be co-sponsoring a conference around the behavioral health vision for Value Based Payments, 
on Tuesday September 27th at the Albany Marriott. 

The conference will include key note speakers from OpenMinds as well as presentations by NYS OMH and OASAS and  MCTAC around the vision for value based payments in behavioral health as well as future technical assistance offerings for providers.

More information, including registration details, will be shared shortly at This training is open to all adult and and child serving NYS behavioral health providers and is geared towards senior leadership and executive management staff.
Value Based Payment Baseline Survey Results

The results from the Value Based Payment (VBP) Baseline Survey are now available and can be found here.

The VBP Baseline Survey results, which reflect 2014 Calendar Year data as reported by the Medicaid MCOs, represent the starting point in achieving the statewide goal of 80-90% of managed care payments to providers using value-based payment methodologies by DY5, as consistent with DSRIP objectives and metrics.
Medicaid Coverage of Social Interventions: A Road Map for States

Social factors, such as income, access to food and housing, and employment status, have a significant impact on the health and health outcomes of Americans, particularly lower-income populations. Federal and state officials who seek to provide Medicaid beneficiaries with quality, cost-effective care acknowledge the need to address these social determinants of health. In developing strategies to do so, states face several challenges, including how to provide a revenue stream to cover the cost of social services, as Medicaid is first and foremost a health insurance program. Nonetheless, under some circumstances, Medicaid is available to cover the costs of social interventions linked to the health of Medicaid enrollees.

A new issue brief from Manatt Health, supported by NYSHealth and Milbank Memorial Fund, outlines opportunities for state Medicaid programs to integrate social interventions into their coverage, payment, and delivery models. The issue brief is based on a review of the relevant laws and regulations, as well as interviews with leading state and federal experts. It offers guidelines for policymakers who want to know when and how states can use Medicaid to facilitate access to social services. Using a pragmatic approach, the issue brief can serve as a road map for clinicians and administrators to navigate the unchartered territory of social interventions through Medicaid.
Analysis Finds Specialty Drugs Rank High Among Medicaid's Most Costly Outpatient Drugs

Costly specialty drugs, such as those used to treat Hepatitis C and HIV, are among the most costly medications in state Medicaid programs, chiefly because of their high prices for a course of treatment, according to a new Kaiser Family Foundation
analysis of Medicaid's most costly outpatient drugs.

Abilify, an antiphsychotic used in the treatment of schizophrenia and bipolar disorder, was the most costly drug in state Medicaid programs overall in the new analysis, which examines the 50 most costly drugs to Medicaid before rebates (which bring down the final cost to the program and vary across drugs) between January 2014 and June 2015. The analysis explains that drugs can be costly to the program because each prescription costs a lot or because they are heavily prescribed - or both.

Hepatitis C drugs Sovaldi and Harvoni rank second and fourth in the analysis, mainly because of the high price for a course of treatment. These drugs cure Hepatitis C in the vast majority of patients and their use spiked over the period of the analysis following their introduction.  Read more here.



HCBS Rates and CFR Webinar for Adult BH HCBS Providers 
Please join MCTAC and state partners for a webinar for Adult BH HCBS Providers. The webinar will cover CFR reporting, reimbursement rates, and information regarding State Aid Grants. 

Thursday, Aug ust 4: 3 - 4 pm. Register here!

Other MCTAC Webinars:

August 24, 12 - 1 pm
September 21, 12 - 1 pm
October 26, 12 - 1 pm




RPC Advisory Call
August 11:  8 - 9 am
GTM Only

RPC Advisory Call
August 25:  8 - 9 am
GTM Only


Officers & Chairs - Call In
September 7:  8 - 9 am

Children & Families Committee
September 13:  11:30 am - 1 pm
GTM Only

RPC Advisory Call
September 15:  8 - 9 am

Fall Full Membership Meeting
September 26 - 27
Woodcliff Hotel & Spa, Fairport

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
Governor Cuomo Announces Action to Ensure Insurers Comply With Mental Health Equity Standards

Governor Andrew M. Cuomo last week announced that the Department of Financial Services has issued guidance to ensure that insurers do not unfairly discriminate against individuals facing mental health disorders. In a  letter , DFS informed health insurers of their responsibility to provide the same level of coverage for mental health and substance use disorders as for medical or surgical care. 

This guidance comes on the heels of recent legislation signed by Governor Cuomo that limits burdensome insurance barriers to access for treatment and medication to treat substance use disorders. Under New York Insurance Law, insurers cannot impose prior insurance authorization for inpatient treatment or for greater access to drug treatment medications. The law also requires insurers to use objective state-designated criteria to determine the level of care for individuals suffering from substance use disorder.  

DFS's letter notifies insurers that the United States Department of Labor and the United States Department of Health and Human Services have jointly issued guidance on compliance with the federal Mental Health Parity and Addiction Equity Act. The MHPAEA requires health insurance plans to provide the same level of coverage for mental health and substance use disorders as for medical or surgical care, including quantitative limitations, such as copays, deductibles, and limits on inpatient or outpatient visits that are covered by the health insurance plan, and Non-Quantitative Treatment Limitations, such as pre-authorizations, providers available through a plan's network, and what a plan considers "medically necessary".   Read more here .
NYS OASAS Awards $1 Million to Expand Substance Use Disorder Treatment in the Southern Tier

The New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) recently awarded $1 million in funding to support 25 new treatment beds to provide care for New Yorkers with substance use disorders. The funding was awarded to Tompkins County addiction treatment services provider Cayuga Addiction Recovery Services for the creation of a new 25-bed adult residential treatment facility.
The residential treatment facility, in Trumansburg, will offer a full spectrum of addiction treatment services to residents including counseling, life-skills training and after-discharge support. These services will be delivered at a new building on the Trumansburg treatment provider's campus, bringing jobs and economic and community benefits to the region, and is aligned with Southern Tier Soaring - the region's comprehensive blueprint for economic growth.  

The funding was made available through a request for proposal administered by NYS OASAS. Cayuga Addiction Recovery Services will receive annual operational costs of up to $1 million once the program is opened. OASAS will work with Cayuga to provide capital funding for construction needs at the treatment space, if needed.

This new 25-bed program is part of the Governor's ongoing efforts to address the heroin and opioid public health crisis. These new beds will help fulfill the Governor's commitment to add 270 treatment beds and 2,335 opioid treatment program slots across the state to help New Yorkers suffering from substance use disorder and to expand vital treatment and recovery resources. Read more  here.
Governor Cuomo Awards $1 Million to Expand Addiction Treatment in Western NY

Governor Andrew M. Cuomo yesterday announced that $1 million has been awarded to Horizon Village, a treatment provider in Niagara County, to assist New Yorkers battling substance use disorders. The funding will support the creation of a new 25-bed treatment facility, advancing Governor Cuomo's multi-pronged approach to combating substance use disorders across the state. The new treatment facility, located in Sanborn, will offer a spectrum of addiction services including counseling, skills training and long-term support.

This new 25-bed program is yet another advance in the Governor's ongoing effort to address the heroin and opioid public health crisis. These new beds will help fulfill the Governor's commitment to add 270 treatment beds and 2,335 opioid treatment program slots across the state to help New Yorkers suffering from substance use disorder and to expand vital treatment and recovery resources. Western New York has also recently received State funding for a family support navigator and on-call peer crisis services, as well as $1.75 million for a Buffalo-based recovery and outreach center. Read more here .
Well-Planned Partnerships Ease the Transition to Medicaid Managed Care 

Community-based agencies have delivered quality healthcare while working under the yoke of a fee-for-service system for too long. Fee-for-service is one of our biggest problems. It is designed to reward volume over value, and measures outputs rather than outcomes. We also lose money on almost every encounter as the reimbursement rates have gone unchanged for eight years.

Illinois has taken a first step towards moving away from fee-for-service to Medicaid managed care. The overarching goal of Medicaid managed care is to create a system to more effectively coordinate care for the increased number of people covered due to Medicaid expansion through the Patient Protection and Affordable Care Act.

Making the shift to this model means we needed to develop strong partnerships with managed care entities. In 2013, we entered into a unique payer/provider partnership with IlliniCare Health/Cenpatico, a subsidiary of Centene Corp. The goal of this one-year pilot program was to improve the lives of 50 of IlliniCare's most complex, high-risk behavioral health patients. The managed care organization paid us a flat rate to manage patients enrolled in its Integrated Care Program, many of whom were not receiving any mental or physical healthcare. Using a strategy of "relentless engagement," the Thresholds' team located the patients and gradually built trusting relationships with them. This new personalized concept, combined with the flat fee that guaranteed payment, allowed Thresholds to creatively pursue the best options for each client. Read more here.
Housing is Seen as Missing Link in Opioid Crisis

It would be foolish to expect an addict - straight out of jail, treatment, or both - to find a sober night's sleep under a bridge, said Jared Owen, a man in recovery.

With not enough housing options in the state, Owens said recovering addicts are frequently left with the forlorn question, "What now?"

Recently, public and private sector leaders from across New England and upstate New York convened in Boston to talk about substance abuse in their states, and how comprehensive housing programs could help curb the crisis.

Marylou Sudders, the state's secretary of health and human services, called for an increased focus in Massachusetts on supportive housing programs, which combine affordable housing and services that help smooth recovery process.

"We need to focus more on the path to recovery, which is really bringing together housing and treatment and employment," Sudders said. "One of the biggest challenges for individuals . . . is finding a safe, drug-free environment to recover in."  Read more here.
With Borders Irrelevant, New York Hospitals Seek Out-of-State Partners

If you stand on a rooftop in Plattsburgh, you can see Vermont across Lake Champlain. So, for Stephens Mundy, president and CEO of Champlain Valley Physicians Hospital, it was only natural that the facility he leads would partner with the University of Vermont Health Network.

"We've been competitors for years and we sat down and said this doesn't make sense," said Mundy, who is also the  board chairman of the Healthcare Association of New York State, a trade group that represents hospitals throughout New York. "The world is changing and our patients and our economic trends have spoken on this. It was a natural."

The state Department of Health approved an affiliation between CVPH Medical Center and Elizabethtown Community Hospital and Fletcher Allen Partners, the previous name for The University of Vermont Health Network, in January, 2013.

UVHM may have been the first out-of-state health system with a footprint in New York but it certainly won't be the last. With state borders increasingly an arbitrary concept for patients, other out-of-state health care systems are looking to work in New York and health care systems within the state are branching out, setting up outposts in other states.  Read more here.
Supervised Injection Sites Could Open in U.S.

A Boston not-for-profit turned heads in April when it opened a safe room where drug users can ride out highs under medical supervision. The Supportive Place for Observation and Treatment, operated under the Boston Health Care for the Homeless program, specifically notes it is not a safe injection facility, therefore, drug-use activity is not permitted  on the property.

Such facilities do exist, though, and they could make their way to the United States shortly. As their name implies, safe injection facilities (SIFs), also known as "drug consumption rooms," provide a location in which users can legally prepare and consume drugs under observation.  

Ithaca, N.Y., Seattle and San Francisco are among the cities weighing the merits of opening the nation's first SIF, with varying degrees of support.  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.