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April 28, 2017

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

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Francine Sinkoff, Editor

Children in Medicaid with behavioral health needs are one of the program's most vulnerable populations - representing a small percentage of the overall Medicaid child population, but accounting for disproportionate costs. These children are often served by multiple public programs, putting them at risk for fragmented or uncoordinated care, and they often experience poor health outcomes at high costs.

Click here to read some highlights of the soon-to-be-released full report, made possible through support from the Annie E. Casey Foundation.
Drug Deaths Surge Again in Upstate New York

The number of drug-related deaths in New York City's suburbs and upstate, including Monroe County, soared a whopping 84 percent between 2010 and 2015, a new report found.

Fueled by a surge in heroin abuse, New York had a remarkable spike in overdoses over the six-year period: Deaths rose 71 percent increase, according to  an analysis of federal data by The Rockefeller Institute of Government.

And the problem was most pronounced in the New York City suburbs and upstate, the institute's report found.

In the city, the annual drug-related deaths rose 45 percent over the six-year stretch, but spiked 84 percent in large upstate counties outside the city.   Read more here.
Grand Opening of New Recovery Community and Outreach Center in Watertown

Pictured 2nd from L:  Pat Fralick, MBA (Lewis Co. DCS); 3rd from L: Roger Ambrose, LMSW (Jefferson Co. DCS)

Governor Andrew M. Cuomo last week announced the grand opening of Anchor Recovery Community and Outreach Center in Watertown. The Center, which will be run by Pivot, will provide critical free programs for people in recovery from a substance use disorder and their families. The Center is supported through a $1.75 million award from the New York State Office of Alcoholism and Substance Abuse Services. 

Anchor Recovery Community and Outreach Center will offer peer support, skill building, recreation, wellness education, employment readiness, and social activities in a safe, welcoming, and alcohol/drug free environment. The Center will also provide information, education, and assistance to the community on how to access addiction treatment and will help people navigate complex insurance and treatment issues. In addition, individuals and families can expect to receive services such as peer-led addiction and recovery support groups; family support and resources; life skills training; linkage with community resources; health and wellness activities; community service opportunities; and education and vocational services.  Read more here.
New Funding Will Expand and Continue Dwyer Program for Veterans in Niagara County

Pictured at podium:  Laura Kelemen, LCSW-R (Niagara Co. DCS) and NYS Senator Rob Ortt

In a joint effort to further improve mental health and well-being among veterans, New York State Sen. Rob Ortt on Thursday joined local veterans, veterans service representatives and Niagara County officials to announce he secured $185,000 in support of the PFC Joseph P. Dwyer Peer Support Program in Niagara County. The program offers support to veterans.

A total of $3.1 million has been secured as part of the 2017-18 state budget to expand the Dwyer program to other counties throughout the state. This year's $185,000 in State Senate funding builds upon the amount Ortt secured in both fiscal years 2016 and 2017 to implement the veterans peer support program in Niagara County. This brings the total amount to $555,000 for Niagara County's Dwyer program.   R ead more here .
Mental Health And Sportsmen Communities Work Together To Prevent Suicide in Ulster County

Nationally,  almost fifty percent of all suicides  involve firearms. 

"People use many different methods to attempt to kill themselves," said Amy McCracken, Deputy Commissioner of the Ulster county Department of Mental Health. "But due to the lethality of guns, the capacity to get medical attention really quickly, people die much more quickly when they use a gun versus other means."

In  partnerships across the country, mental health professionals like McCracken and gun enthusiasts are trying to do something about suicide. One such partnership is in Ulster County, New York, in the Hudson Valley. McCracken and Joe Liuni of the Federated Sportsmen's Clubs of Ulster County talked to Crystal Sarakas about their collaboration.   Read more here .
Increased Training Helps Prevent Suicides Inside Albany County Correctional Facility 

Albany County Sheriff Craig Apple says increased training has helped them handle potential suicide cases inside their prison walls.

"Suicide is something that every jail administrator, it's their worst nightmare," Sheriff Apple said.

Sheriff Apple says suicide in jail cells is a nightmare, simply because it's hard to stop.
"If somebody's insistent on taking their own life they're going to figure out a way inside that facility to do it."

To help prevent suicides here, Albany County has increased officer training and check cells hourly and sometimes every 15 minutes.   Enhanced evaluations of inmates when they first enter jail and separate those who may try to take their own life.  In severe cases, those on potential suicide watch, officers stand by literally.  R ead more here .
New Affordable-Housing Community in the Bronx Provides Opportunity for People with Mental Disabilities to Live Independently

During a ribbon-cutting ceremony recently, community leaders, affordable-housing advocates and key investment partners celebrated the opening of Gouverneur Place Apartments, a new 68-unit affordable-housing development in the Bronx that integrates high-quality affordable housing with supportive services for residents.

The seven-story affordable-housing community, located at 450 Gouverneur Place, is being applauded as a model public-private partnership. The State of New York and UnitedHealthcare were the largest investors in the new $20.7 million development, which features a mix of studio, 1- , 2- and 3-bedroom apartments, and onsite amenities that include a computer lounge, community room, supportive services, laundry room, bike storage, and outdoor courtyard and recreation area.

An innovative program by the New York State Office of Mental Health (OMH) is providing housing opportunities for people with mental health disabilities through funding and program support for 50 of the residents. Seventeen of the apartments are available to individuals and families earning up to 60 percent of Area Median Income (AMI). An on-site residential building manager will occupy the remaining apartment. Read more here.
OMH Announces Availability of $75,000 in Funding for Stigma Reduction Projects

The New York State Office of Mental Health (OMH) recently announced the availability of up to $75,000 in grant funding for projects that help reduce the stigma often associated with mental illness. 

This funding represents the revenues received through a voluntary tax check-off program launched in 2016. This program allows taxpayers to contribute easily to the 'Mental Illness Anti-Stigma Fund' when filing their NYS taxes.

The Office of Mental Health will provide 15 grants of up to $5,000 each to support year-long stigma-reduction projects. Agencies must have at least one year of experience serving individuals with mental illness in order to qualify.   Read more here .


May 3, 1 - 2 pm, Behavioral Healthcare Executive

May 10, 1 - 2 pm, Health Management Associates

May 11, 1:30 - 3 pm, Center for Healthcare Strategies

May 11, 2 - 3:15 pm, Stepping Up Initiative

May 16, 12 - 1 pm, PsychU

May 17, 3 - 4:30 pm, Rural Behavioral Health

Responding to Natural Disasters in Rural Communities
June 21, 3 - 4:30 pm, Rural Behavioral Health

August 16, 3 - 4:30 pm, Rural Behavioral Health


MAY 2017

Officers, Chairs & Regional Reps Call
May 3:  8 - 9 am, GTM

Mental Health Committee Meeting
May 9:  10 - 11:30 am, GTM

Chemical Dependency Committee Meeting
May 12:  11 am - 12:30 pm, GTM

Children & Families Committee Meeting
May 16:  11:30 am - 1 pm, GTM

Directors & Executive Committee Meeting
May 17:  9:30 am - 12:30 pm, GTM

CSPOA / DOH / OMH Monthly Call
May 18:  3 - 4 pm, GTM

OMH Agency Meeting
May 23:  10 am - 12 pm
44 Holland Ave., 8th Fl., Albany

OASAS Agency Meeting
May 23:  1 - 3 pm
1450 Western Ave., 4th Fl., Albany

CLMHD Office Closed
May 29:  Memorial Day

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
CLMHD Holds Annual Spring Full Membership Meeting 

The Conference recently held its Annual Spring Full Membership Meeting on April 24 - 25. Directors of Community Services (DCSs) from across the state convened at the Holiday Inn in Saratoga Springs to exchange ideas and best practices with their colleagues.

Monday morning kicked off with a keynote presentation by NYS Medicaid Director, Jason Helgerson, entitled, "A Path Forward: The Move to DSRIP, VBP, and Behavioral Health Integration."   Helgerson explained that improving behavioral health will be a major factor for statewide performance, and recognized that Directors of Community Services play an integral role in the success of New York's  health care system transformation .

In the afternoon, members participated in the Conference's business meeting, which began with CLMHD Executive Director Kelly Hansen providing an overview on the future of health care delivery, the importance of embracing new technology, and what the Conference and LGUs need to be cognizant of as we move forward. The business meeting also included updates on CLMHD's RPC  initiative, and members participated in a discussion around statewide issues which directly impact mental hygiene service delivery and local government oversight.

On Tuesday, Kirstein DonVito, Deputy Commissioner - Clinical, Rensselaer County Department of Mental Health, explained to members how her LGU is using OMH's PSYCKES database for care coordination and development of the county's local services plan.  The day concluded with updates from representatives of the three state disability agencies.  Many thanks to Robert Myers, Ph.D., LMSW, NYS OMH Senior Deputy Commissioner and Director, Division of Adult Services; Pat Lincourt, LCSW-R, NYS OASAS Director, Division of Practice Innovation and Care Management;  and Helene DeSanto, NYS OPWDD Acting Executive Deputy Commissioner, for their participation.

Following another successful event, the Conference would like to congratulate the following members on their upcoming retirement:

- Art Johnson, LCSW, Commissioner
Broome County Mental Health Department

- Nancy Balbick, LCSW-R, Director of Community Services, Wyoming County Mental Health Department

- Amy McCracken, LCSW-R, Deputy Commissioner, Ulster County Mental Health Department

CLMHD Chair, Joe Todora, LMSW, MSW, welcomes members

Jason Helgerson, NYS Medicaid Director

Robert Myers, Ph.D., NYS OMH  Senior Deputy Commissioner & Division Director for Adult Services, State Hospitals and Managed Care
NYS Launches VBP Pilot Program 

The Medicaid Redesign Team recently announced the launch of the State's first Value Based Payment (VBP) Pilots. The Pilot Program is a first of its kind, two-year program, intended to create momentum in the transition from a fee-for-service to a value based payment environment. VBP Pilots are expected to help the State meet MRT waiver goals by not only establishing early successes, but also through providing invaluable input into the design of VBP in New York State.

Seven (7) provider organizations and eight (8) Managed Care Organizations (MCOs) located throughout the State will be working together as part of the Pilot Program on 13 distinct contracts. These contracts will pilot three (3) types of value based payment arrangements: Health and Recovery Plan (HARP) Subpopulation, Integrated Primary Care (IPC), and Total Care for the General Population (TCGP).

These arrangements are  contracted as per the standards outlined in the VBP Roadmap and pilot organizations are required to take on downside risk-sharing VBP responsibilities by the second year of the Program. Pilot organizations will play critical roles in evaluating the validity, feasibility, and reliability of quality measures for their respective arrangements, while also sharing feedback on core aspects of the VBP process (from contracting and financial risk sharing, to use of the Medicaid Analytics Performance Portal (MAPP) analytics).

For their pivotal role as early adopters, VBP pilot organizations will receive support from the Department of Health, and in turn, they will be active participants in providing lessons learned and sharing best practices for statewide VBP implementation.

An additional pilot will be launched in Albany County that will bring together pediatric providers and early childhood stakeholders with MCOs to focus on school readiness.

Click here to view the list of participating VBP Pilot organizations. 

To learn more about VBP click here .
Make Kendra's Law permanent: Manhattan Institute

Kendra's Law, a 1999 statute permitting court-ordered community-based treatment for people with serious mental illnesses, is set to expire June 30. The Manhattan Institute  published a report  Thursday that supports making it permanent.

Kendra's Law aims to connect people with serious mental illnesses to "assisted outpatient treatment" if they have a history of hospitalizations or violence. It is named for Kendra Webdale, a woman who was pushed in front of a subway train in 1999 by a man with a history of mental illness.

People with serious mental illnesses make up a disproportionate percentage of the city's homeless-shelter residents and people in jails and prisons. While 4% of New York City adults have a serious mental illness, that number is 11% among inmates and 25% in homeless shelters.

City participants in assisted outpatient treatment were more than 60% less likely to be hospitalized, incarcerated or in a homeless shelter than they were prior to the intervention, state  Office of Mental Health data show.
Critics of the law argue it infringes upon participants' constitutional rights by forcing compliance with a treatment plan without a judicial finding of incapacity. But the law has withstood constitutional challenges,  according to an OMH report.

Companion bills in the state Senate and Assembly ( S516A604) would make the law permanent.  
The bills' passage "would acknowledge we have a problem getting people to treatment and we need to secure resources and services for the hardest-to-treat seriously mentally ill individuals," said Stephen Eide, a senior fellow at the Manhattan Institute and the report's author.

Kaiser Family Foundation Report: The Role of Medicaid in Rural America

A new brief  from the Kaiser Family Foundation examines the role of Medicaid in rural America. The 52 million children and nonelderly adults living in the most rural areas of the U.S. are more likely to be low income, more likely to have a disability and less likely to be employed or to have private insurance coverage compared to residents of urban and other areas.  Individuals in rural areas also face significant barriers to accessing care, including provider shortages, recent closures of rural hospitals, and  long travel distances to providers.

The brief explains that Medicaid plays a central role in helping to fill the gaps in private coverage in rural America, covering nearly one in four (24%) nonelderly individuals in rural areas.  The brief also includes state-level data as well as a link to a county-based map highlighting rural areas of the country. 
A Public Health Crisis In Rural America

Since the turn of the century, we've seen an interesting and troubling new trend - one that I don't think anyone else predicted beforehand. And it's only received mainstream attention in the past year or two. I'm talking about the simultaneous rise in mortality rates and decline of access to medical care throughout the rural United States, problems that have been exacerbated by the opioid crisis. I was reminded of this situation by some recent headlines from [Open Minds] Weekly News Wire articles:  Premature Death Rates Rise In 20% Of Rural Counties Over The Past Decade  and  Methadone Accounted For 23% Of Prescription Opioid Overdose Deaths In 2014 .

What do we mean when we talk about rural America? The U.S. Census Bureau has two classifications of urban areas: urbanized areas (UAs) that are home to 50,000 people or more, and urban clusters that have somewhere between 2,500 and 50,000 residents. Any people living outside of those two zones are considered to be rural. In the 2010 Census, they accounted for 19.3% of the total population, which works out to approximately 60 million Americans (see  Defining Rural at the U.S. Census Bureau).

While it makes up less than one-fifth of the people, rural America accounts for a vast majority of the U.S. landmass, as seen in the map of the 48 contiguous states below.

Read more here.
Evidence On Payment Reform: Where Are The Gaps? 

The US health care system is transforming how it pays for and delivers care. New payment models and benefit designs aim to promote and sustain improvements in health and care delivery, specifically focusing on better outcomes and lower costs. Supporting better payment policies is increasingly critical as rising costs affect the ability of individuals to afford coverage.

However, the transition to new models is not easy. Published studies of payment reforms have shown mixed results, leaving providers, payers, purchasers, and patients uncertain about how to proceed.

There is a strong consensus among health care stakeholders about the need for better evidence on the impact of payment reforms. Better evidence would give providers and the public more confidence in implementing payment and delivery reforms-and also knowing which ones to avoid. Evaluations can help stakeholders identify where to make necessary changes. In short, better evidence would ensure that we realize the promise of payment reforms to improve care and reduce costs.

To accelerate the development of better evidence, the Duke-Margolis Center for Health Policy established the  Payment Reform Evidence Hub.   Read more here .
National Quality Forum Proposes Changes To Inpatient Mental Health Performance Measures

Just when you finished your performance dashboard, it looks like the performance measurement set is going to change. Last month, the National Quality Forum's (NQF) Measure Applications Partnership (MAP) recommended that the federal government remove 51 health care quality measures from the 240 sets used in federal health care value-based purchasing, public reporting, and other programs (see  NQF Recommends Updated Quality Measures For HHS). This includes seven measures specifically related to behavioral health.

If you're unfamiliar with it, the MAP is a partnership between 90 private-sector organizations and seven federal agencies that recommends measures for private sector payers and advises the U.S. Department of Health and Human Services (HHS) on the selection of performance measures for federal health programs and payers.   Read more here .
Severe Shortage Of Home Health Workers Robs Thousands Of Proper Care

Acute shortages of home health aides and nursing assistants are cropping up across the country, threatening care for people with serious disabilities and vulnerable older adults.
In Minnesota and Wisconsin, nursing homes have denied admission to thousands of patients over the past year because they lack essential staff, according to local long-term care associations.

In New York, patients living in rural areas have been injured, soiled themselves and gone without meals because paid caregivers aren't available, according to testimony provided to the state Assembly's health committee in February.

In Illinois, the independence of people with severe developmental disabilities is being compromised, as agencies experience staff shortages of up to 30 percent, according to a court monitor overseeing a federal consent decree.

The emerging crisis is driven by low wages - around $10 an hour, mostly funded by state Medicaid programs - and a shrinking pool of workers willing to perform this physically and emotionally demanding work: helping people get in and out of bed, go to the bathroom, shower, eat, participate in activities, and often dealing with challenging behaviors.  Read more here.
How to Avoid a Medicaid Managed-Care Fiasco

Illinois' meltdown highlights importance of keeping providers happy and coordinating care 

Health system CEO Mary Starmann-Harrison said she and her staff tried to be patient in dealing with Molina Healthcare's Medicaid managed-care plan in Illinois.

Approving a provider at one her hospitals to be in-network sometimes took as long as six months, said Starmann-Harrison, CEO of Hospital Sisters Health System, which has 13 hospitals across Illinois and Wisconsin.

Prior authorizations were difficult to get and reimbursement was slow and unreliable. Her system complained repeatedly about these issues but to no avail. "We tried for a solid year to work with (Molina) on the operational issues, and we just felt we're at a point where we were not serving the patient well," she said.

So, HSHS last December stopped dealing with Molina.   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.