Advancing Public Policies for People with Mental Illness, Chemical Dependency or Developmental Disabilities
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Final Revised NYS DOH Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs
Click
here to access the FINAL versions of the following documents:
- New York State Department of Health Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs
- Standard Clauses for Managed Care Provider/IPA/ACO Contracts
- Provider Contract Statement and Certification form (DOH-4255) fillable
These documents were revised to modify the contract submission and review process to reflect Value Based Payment arrangements pursuant to the New York State Value Based Payment Roadmap and the Regulatory Impact Subcommittee.
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Simple Recovery Sees In-Network Status as Sustainability Strategy
Stephen Odom, PhD, CEO of New Vista Behavioral Health, believes history might be repeating itself.
"When managed care began in the early 1990s, it was a response to out-of-network pricing and paying claims at high rates," Odom tells Behavioral Healthcare Executive. "In the last few years, since the Affordable Care Act (ACA), payers were just paying claims and decided they were not going to take it anymore and started shrinking the usual-and-customary rates or changing schedules to Medicare-plus rates. There's been a squeeze on out-of-network payments."
New Vista's Simple Recovery treatment program in California recently secured in-network status for Anthem Blue Cross-its 14th managed care contract. Odom says some of Simple Recovery's payer partners are reimbursing higher rates than they would for out-of-network.
"Anybody who wants to have a sustainable model is going to have to have some in-network, some out-of-network and some self-pay," he says.
With forthcoming new federal healthcare policy and the unknowns of future implementation, negotiating managed care contracts might be a solid strategy for providers today. Read more
here.
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Perspectives On In-House Pharmacies & Mental Health
The past few weeks, we've written about the role of medication in integrated care coordination - and how important it is for managers of provider organizations to understand medication best practices, the relationship between consumer engagement and medication adherence, and consumer access to medications through their pharmacy benefits
. But one area we haven't covered is how medications make their way to the consumer.
In 2016 there were an estimated 61,863 pharmacies in the United States. Of these, about 85% can be classified as a community-based retail pharmacy (located in a drug store, grocery store, or department store). Generally under this model, consumers interact directly with the pharmacist to fill prescriptions from physicians and clinicians. Of the remaining pharmacies, less than one percent are located in schools and universities or are corporate owned facilities; and about 14% can be classified as an "in-house" pharmacy, meaning that they are located inside a hospital, walk-in clinic, medical center, or nursing home. Under this model, pharmacies have more opportunities to interact closely with prescribers, have access to medical records, influence treatment, and monitor drug use patterns (see
National Pharmacy Market Summary). Read more
here.
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UPCOMING TRAININGS
MCTAC
April 5, 12 - 1 pm
May 11, 1 - 2 pm
June 8, 12 - 1 pm
OTHER TRAININGS
March 22, 1 - 2:30 pm, SAMHSA
March 22, 12 - 12:30 pm, National Council
March 23, 3 - 4:30 pm, Urban Institute & Manatt Health
March 23, 12 - 1 pm, HHS
March 23, 2 - 3 pm, SAMHSA
March 29, 12 - 12:30 pm, National Council
March 30, 2 - 3:30 pm, SAMHSA GAINS Center
June 21, 3 - 4:30 pm, Rural Behavioral Health
August 16, 3 - 4:30 pm, Rural Behavioral Health
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Children & Families Committee
March 21: 11:30 am - 1 pm, GTM
RPC Leads & Coordinators Call
March 23: 8 - 9 am,
GTM
Officers, Chairs & Regional Reps Call
April 5: 8 - 9 am
RPC Leads & Coordinators Call
April 6: 8 - 9 am,
GTM
Mental Health Committee
April 6, 11 am - 12:30 pm, GTM
Chemical Dependency Committee
April 7: 11 am - 12:30 pm,
GTM
Children & Families Committee
April 18: 11:30 am - 1 pm, GTM
Directors & Executive Committee Combined Meeting
April 19: 9:30 am - 12:30 pm, GTM
RPC Leads & Coordinators Call
Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422
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New Upstate Psychiatric Program Targets Suicidal Teens, Young Adults
Upstate Medical University is launching a program targeted at treating youth and young adults at risk for suicide or other self-harming behaviors. This comes at a time when central New York has a suicide mortality rate greater than the state or national average.
Finding psychiatric help for teens or young adults in central New York is often very hard. Families often run into medical roadblocks -- referrals, long waiting lists and simply not enough services to go around.
The new high risk psychiatry program hopes to change that by offering families a treatment called dynamic deconstructive psychotherapy, developed by Upstate psychiatry professor Robert Gregory. He says the therapy, which gets a positive response in 90 percent of patients, rewires the brain, to change the way teens and young adults handle emotions.
"Patients practice processing their emotions and experiences from recent social interactions, in a different way from what they're used to doing. They're used to using different avoidance mechanisms, like substance use disorders or distractions, instead of being able to acknowledge and identify their emotions," said Gregory. Read more
here.
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Governor Cuomo Announces Grand Opening of Affordable and Supportive Housing Development in Cortland
Governor Andrew M. Cuomo today announced the grand opening of the $7.5 million Riverview Apartments development in the City of Cortland. The two-story, 39-unit building provides affordable housing for low-income families and for individuals in need of behavioral health services.
Riverview Apartments, located at 6-10 Riverview Avenue in a newly constructed 17,306 square-foot building, was development by Catholic Charities of Cortland County and Christopher Community Inc. The new apartment building includes nineteen units for low-income individuals and families. Twenty units will be occupied by residents receiving emergency support through Catholic Charities and behavioral health services, including case management, peer support, and linkage to home health providers. Read more here.
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Provider/Health Plan Relationships Moving From Dependence To Interdependence
In the not too distant past, the relationship between health plans and the provider organizations that served their members could best be described as a "vendor" relationship. Health plans "shopped" for provider vendors based on service characteristics, location, and price.
But the market changed with the end of preexisting condition exclusions and no annual/lifetime limits - and the move of health plans into Medicaid and Medicare. More members with bigger needs were being served within the health plan. And, the ability of the health plan's network of service provider organizations to manage consumers with high-needs and complex support requirements has evolved into a significant differentiation.
The new relationship is moving toward interdependence, with health plans expecting care collaboration, health information, and gainsharing from their contracted provider organizations. All have a common requirement: organizational leadership that can recognize the interdependence that can make organizations successful. Read more
here.
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By Itself, Reimbursement Doesn't Expand SBIRT
Health settings have historically not done well when it comes to addressing substance use.
More often than not, medical
professionals
sidestep drugs and alcohol altogether
, even though substance use is a significant factor in many injuries and illnesses. And when medical settings
do
address substance use, sometimes it's messy.
"For some reason, when I walked into his office and he asked me if I did any drugs, I decided to be honest and told him that I was regularly doing cocaine. 'What?' he asked, clearly horrified; I made an instant decision never to be honest with a doctor again."
Enter SBIRT. SBIRT stands for
Screening, Brief Intervention, and Referral to Treatment and it's a strategy to create routine conversations about drugs and alcohol in health settings using scientifically-validated questionnaires. It's a simple notion: ask everyone. If someone's substance use appears risky, talk about it nonjudgmentally. If someone seems to need additional help, help her find it.
SBIRT is not complicated, nor is it newfangled. It was developed more than 30 years ago and has been adapted for dozens of settings and populations. However,
as we've written about before, SBIRT practices are too-often seen as add-ons supported by grant funding, rather than a part of normal healthcare delivery. Read more
here.
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Supervisors Seek to Reduce Ontario County Jail Population
The Ontario County Board of Supervisors has backed several measures designed to reduce the number of inmates incarcerated at the county jail - and to lower costs related to the operation of the facility.
At their meeting Thursday night, supervisors approved resolutions that came from a group dubbed the "Campbell Commission," which is made up of supervisors, county department heads and members of community organizations. It started meeting last fall to look at new programs that would lower the jail population. The group meets twice a month.
One measure the board approved was a contract for a weekend jail alternative program with the Finger Lakes Area Counseling & Recovery Agency. It offers courts in the county an alternative sentencing option for some drug offenders. Read more
here.
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To Battle The Opioid Overdose Epidemic, Deploy The 'Cascade Of Care' Model
Despite a
plateau in opioid prescribing, opioid-related overdose deaths have continued to climb in epidemic proportion. Much of the recent rise is related to unpredictable adulteration of heroin and black market pills with fentanyl and other potent synthetics. However the death rate also reflects longstanding treatment gaps; a majority of the 2.4 million individuals in the United States with an opioid use disorder
do not receive evidence
based medication-assisted treatment (MAT) with methadone, buprenorphine, or long-acting injectable naltrexone.
The 21st Century Cures Act charged the Substance Abuse and Mental Health Services Administration (SAMHSA) with disbursing nearly $1 billion over the next two years, prioritizing states hardest hit by overdose. SAMHSA's State Targeted Response to the Opioid Crisis Grants (STR)
funding announcement requires that states perform needs assessments and develop strategic plans for increasing access to evidence-based treatment with MAT under a chronic care model. Further, states are to periodically review performance data they report to SAMHSA, develop performance measures to assess progress, and use this information to improve management. A unifying framework with standardized benchmarks to track uptake of MAT and patient outcomes across states would contribute greatly to this effort to reduce overdose death, especially if funding is linked with outcomes.
Fortunately, there is a model from the recent past policymakers can draw upon to formulate such a framework. Within two years of the introduction of anti-retrovirals for the treatment of HIV in the mid-1990s, the US AIDS mortality rate
was cut in half. Precedent for the rapid uptake of a lifesaving treatment across the health care system producing rapid and measureable population level benefits provides hope for ameliorating the rising toll of opioid-related overdose deaths. Revisiting how the public health community established the systems needed to achieve this result can serve as a useful guide for states and policymakers to set up the most effective response to the current crisis. Read more
here.
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As Opioid Overdoses Rise, Police Officers Become Counselors, Doctors and Social Workers
The nation's opioid epidemic is changing the way law enforcement does its job, with police officers acting as drug counselors and medical workers and shifting from law-and-order tactics to approaches more akin to social work.
Departments accustomed to arresting drug abusers are spearheading programs to get them into treatment, convinced that their old strategies weren't working. They're administering medication that reverses overdoses, allowing users to turn in drugs in exchange for treatment, and partnering with hospitals to intervene before abuse turns fatal.
"A lot of the officers are resistant to what we call social work. They want to go out and fight crime, put people in jail," said Capt. Ron Meyers of the police department in Chillicothe, Ohio, a 21-year veteran who is convinced that punitive tactics no longer work against drugs. "We need to make sure the officers understand this is what is going to stop the epidemic."
Officers are finding children who were barricaded in rooms while their parents got high, and they are responding to the same homes for the same problems. Feelings of exasperation course through some departments in which officers are interacting with the same drug users over and over again, sometimes saving their lives repeatedly with naloxone, a drug that reverses an opiate overdose.
"You're tired of dealing with this person because it saps your resources and it's frustrating, and sometimes that manifests itself in a poor attitude or police officer becoming cynical or sarcastic," said Officer Jamie Williamson of the police department in Ithaca, N.Y., where he said heroin is on every corner of the city. "But you want to get them the help so you don't have to deal with them and so that person gets to a better place." Read more
here.
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