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September 7, 2017

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

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Francine Sinkoff, Editor

Children's Medicaid System Transformation Refresher

The NYS DOH, OASAS, OCFS, OMH, and OPWDD will be hosting a joint webinar presentation on Monday, September 18 from 1:00 pm - 2:30 pm which will focus on the Medicaid Children's System Transformation. The presentation will provide a refresher course on the key elements of the children's transformation including time frames, expansion of services, transition to Medicaid Managed Care and important readiness activities providers should be engaged in now.  We encourage Health Home leadership, Care Management Agencies, current 1915(c) Waiver providers, applicants for expanded services and all interested stakeholders to attend. 

Register for the refresher here.   After registering, you will receive a confirmation email containing information about joining the webinar.
NQF Releases Behavioral Health 2016-2017 Final Report

Mental illness and substance use disorders are leading causes of disability and premature mortality in the United States. Access to quality behavioral healthcare is essential to leading a healthy, productive life. Given that one in five American adults experience a mental illness in a given year, performance measurement in this area needs to remain operational and current. 

This report is the fourth in a series of reports describing the National Quality Forum's (NQF) measure evaluation projects for behavioral health measures. The multiphase project aims to endorse measures of accountability for improving the delivery of behavioral health services and achieving better behavioral health outcomes for the U.S. population. In this phase, the Behavioral Health Standing Committee evaluated 13 measures related to tobacco use, alcohol and substance use, attention deficit hyperactivity disorder, depression, medication continuation and reconciliation, and follow-up after hospitalization for mental illness. The Committee recommended nine measures for endorsement, three measures were not recommended, and one measure recommendation was deferred.

Click here to view the full report.
Unraveling the Mysteries of the Addicted Brain

Today's war on drugs isn't fought by first ladies or celebrity advocates. Armed with MRI machines, electromagnetic pulses and experimental drugs, scientists are on the battle's front lines.

In the cover story of  September's National Geographic, Fran Smith explores the different fronts of a war being fought in laboratories and universities all over the world. Armed with the tools of science and with the help of people who struggle with addictions to substances and self-destructive behavior, researchers are working to unravel the mysteries of the addicted brain.

Smith's account is accompanied by powerful photos by Max Aguilera-Hellweg. The article is packed with descriptions of ¬≠cutting-edge treatments such as transcranial magnetic stimulation. TMS sends electromagnetic pulses to a patient's prefrontal cortex. Researchers think this might reboot the addicted brain and stop cravings in their tracks.  Read more here.

September 8, 2 - 3 pm, OMH

September 12, 2 - 3:30 pm, Otsuka Pharmaceuticals

September 12, 2:30 - 3:30 pm, National Council for Behavioral Health

September 12, 3 - 4:30 pm, SAMHSA

September 13, 2:30 - 3:30 pm, National Council for Behavioral Health

September 13, 3 - 4:30 pm, SAMHSA-HRSA

September 14, 12 - 1 pm, PsychU

September 19, 1 - 2 pm, Pathways RTC

Enable Access to Client-Level Data in PSYCKES
September 20, 10 - 11 am, OMH

September 28, 12 - 12:30 pm, PsychU

October 12, 2 - 3:15 pm, Stepping Up 

October 19, 2 - 3:15 pm, Stepping Up


Fall Full Membership Meeting
September 11 - 12
Crowne Plaza, Lake Placid

Children & Families Committee Meeting
September 19:  11:30 am - 1 pm

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

Children & Families Committee Meeting
October 17:  11:30 am - 1 pm,  GTM

Mental Hygiene Planning Committee Meeting
October 17:  1 - 3 pm,  GTM

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

OMH Agency Meeting 
October 24:  9 am - 12 pm
44 Holland Ave., Albany

OASAS Agency Meeting
October 24:  1 - 4 pm
1450 Western Ave., Albany

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
Margaret Hirst, LCSW, Dutchess County DCS, to be Honored by NAMI Mid-Hudson at 2017 Gala

Margaret Hirst, Deputy Commissioner for the Department of Behavioral and Community Health and Director of Community Services for Dutchess County is the recipient of the 2017 HOPE Award.

Hirst will be honored at NAMI's annual gala on Wednesday, Sept. 13 from 5 p.m. to 9 p.m. at the Grand View in Poughkeepsie.
NAMI said they are honoring Hirst for her commitment to advocate for patient centered recovery oriented mental health programs. She also was instrumental in opening the Dutchess County Stabilization Center, NAMI said.

Through the years, Margaret has helped to initiate many new services and programs such a community-based re-entry teams in adult homes, a mobile mental health program to reach individuals who have difficulty keeping appointments, treatment programs as alternatives to incarceration, including drug courts and pre-trial diversion services, and chemical dependency and mental health treatment for individuals who are intellectually and developmentally disabled. She has been an active member of the Criminal Justice Council since 1999.

Congrats, Margaret!
City Hospital System Is Expanding Children's Mental Health Programs

Recognizing that negative childhood experiences can affect a person's health long into adulthood, New York City's public hospital system is expanding its mental health programs for children and adolescents.

The programs, which NYC Health & Hospitals plans to announce on Wednesday, are designed to address the challenges facing many of the hospital system's young patients, such as poverty, violence and substance abuse - circumstances that doctors said make children more likely to need mental health treatment but less likely to get it.

The programs follow the increasingly popular "integrated care" model, which aims to minimize the bouncing of patients between physical health doctors, psychiatrists and community resources. Instead, previously isolated services are brought into tandem.

The HealthySteps program, for example, pairs a social worker or psychologist with pediatricians, so parents can receive advice on how to structure playtime or gain access to food stamps at the same time as their newborn receives immunizations. Project TEACH trains pediatricians to diagnose and prescribe medication for common disorders such as depression and anxiety. And the 100 Schools Project coaches teachers and guidance counselors on identifying trauma or substance abuse in middle and high school students.  Read more here.
Notice: Posting of Potential Lead Agencies for NYS BH VBP Readiness Program

New York State has concluded a review of the submitted Notifications of Interest for the NYS BH VBP Readiness Program.  We are posting the contact information of the potential Lead agencies for the program here .  Inclusion in this posting does not guarantee selection as a lead agency in a Behavioral Health Care Collaborative (BHCC).   
NYS does not have the resources to fund this many BHCCs.  From the initial review, it is clear many will not have an adequate number of Medicaid recipients served and/or a comprehensive network to receive funding.  All BHCCs that apply must have a comprehensive network of providers that encompass the full continuum of Mental Health and Substance Use Disorder services. NYS strongly encourages collaboration on the application. 
If an agency is interested in joining a BHCC they should outreach the Lead agencies in your region serving the same managed care enrolled individuals.
Please contact  or with any questions. 
NQF Unveils Quality Measurement Framework Plan for Telehealth

Telehealth and telemedicine can make a positive impact on the nation's healthcare system if they demonstrate improvement in health outcomes, processes and cost, quality measures are widely accepted and the definitions of measurement are consistent.

That's the gist of a  National Quality Forum report issued Aug. 31, which aims to set a national framework for measuring and supporting success in telehealth and telemedicine.

To evaluate a program, the NQF laid out four basic categories: access to care, financial impact to patients and their care providers, patient and clinician experience, and effectiveness of both the clinical and operations systems.  Read more here.
Healthcare's Growing Focus on Behavioral Health Data Exchange
Behavioral Health
EHR adoption and health data exchange have steadily increased across most care settings as a result of the EHR Incentive Programs.

While the benefits of exchanging patient medication histories, visit summaries, and medical condition information are widely known, providers are only recently becoming more interested in incorporating behavioral health data into primary care.

Last year, researchers  in a study published in the Journal of American Medical Informatics Association (JAMIA) began investigating the lack of behavioral health data in primary care EHR technology.

Researchers found that 27.3 percent of patients with depression and 27.7 percent of patients with bipolar disorder lacked a diagnosis of their mental illness in their primary care EHRs. In addition, data about mental health patient-provider encounters occurring in non-primary care settings were often nowhere to be found in the primary care record. Furthermore, nearly 90 percent of acute psychiatric services at hospital facilities - often representing the most severe treatment of mental illness - were not present in the EHR whatsoever.  Read more here.
EHR Natural Language Processing Flags Social Determinant Search Terms

Applying natural language processing (NLP) techniques to the electronic health record can help providers identify key terms associated with the social determinants of health, says  a new study out of Massachusetts General Hospital.

Using QPID, an ontology-driven word recognition software developed at MGH, to scan EHRs researchers were able to compile a list of 22 search terms that could highlight high-risk Medicaid patients in need of enhanced care coordination with an accountable care environment.

"Patients enrolled in Medicaid can often have a variety of upstream social factors that can influence their health, such as housing and employment instability and food insecurity, collectively known as  social determinants of health , as well as mental health conditions and substance abuse." 
Read more here .
In New York State, A Glimmer Of Good News About The Opioid Crisis

After years of rising opioid mortality, opioid deaths in most New York counties fell between 2015 and 2016, according to  new numbers from the New York State Department of Health.

Excluding New York City, which is counted separately and where opioid deaths rose during the same period, there were 1,238 opioid deaths in New York state last year, compared to 1,520 deaths the year before. Overdose deaths take time to confirm, and it's possible the new report's numbers could change, but the apparent improvement comes amid growing use of the overdose reversal drug naloxone - lending credence to the public health theory that increased access to naloxone helps prevent opioid deaths.

"The increased use of naloxone in New York State reflects both the ongoing opioid epidemic as well as increased access to this life-saving medication," Jill Montag, a state health department spokeswoman, told HuffPost in an email. "County health departments - as well as treatment programs, community-based organizations and public safety agencies - have taken critical roles in working with the state to expand this capacity."  Read more here.
The First Count of Fentanyl Deaths in 2016:  Up 540% in Three Years

Drug overdoses killed roughly 64,000 people in the United States last year, according to the first governmental  account of nationwide drug deaths to cover all of 2016. It's a staggering rise of more than 22 percent over the 52,404 drug deaths recorded the previous year - and even higher than The New York Times's estimate in June, which was based on earlier preliminary data.

Drug overdoses are expected to remain the leading cause of death for Americans under 50, as synthetic opioids - primarily fentanyl and its analogues - continue to push the death count higher. Drug deaths involving fentanyl more than doubled from 2015 to 2016, accompanied by an upturn in deaths involving cocaine and methamphetamine. Together they add up to an epidemic of drug overdoses that is killing people at a faster rate than the H.I.V. epidemic at its peak.

This is the first national data to break down the growth by drug and by state. Read more here.

Does Federal Uncertainty Mean More Or Less Medicaid Managed Care?

What happens in Medicaid is important for many provider organizations and many health plans. Medicaid is now one of the largest funders of health benefits and many specialty provider organizations have a large proportion of their revenue coming from Medicaid beneficiaries. What we have seen over the past few years, is a steady increase in the proportion of the Medicaid beneficiaries in some type of managed care program, which has now reached 70%.

But with the uncertainty in Washington-the now-aborted repeal of the Patient Protection and Affordable Care Act (PPACA), the specter of state block grants, and the uncertainly about the direction of Tom Price, M.D., Secretary of the Health and Human Services, getting a sense of direction is difficult. One question that our team often debates is whether we'll see more Medicaid managed care - or if the state reliance on managed care will slow or reverse. Recently two events gave us pause and make it more difficult to "read the tea leaves." Both Alabama and Oklahoma canceled plans to implement comprehensive managed care programs citing concerns with federal funding and opportunities for more flexible Medicaid spending.  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.