Advancing Public Policies for People with Mental Illness, Chemical Dependency or Developmental Disabilities
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CMS Nominee Wants To Protect States and Rural Providers, Opposes Vouchers for Medicare
Seema Verma, the nominee to lead the CMS, said during her confirmation hearing Thursday that she may claw back parts of a rule that overhauled managed Medicaid programs. She also opposes turning Medicare into a voucher program and thinks rural providers shouldn't face risk in alternative payment models.
Verma told the Senate Finance Committee that one of her first priorities will be re-assessing a rule issued under the Obama administration that required states to more vigorously supervise the adequacy of plans' provider networks and encouraged states to establish quality rating systems for health plans. Verma said she wanted to determine whether the rule would burden states.
"States will spend millions of dollars implementing that particular regulation, and we have to ask ourselves what will we achieve?" asked Verma, wondering if it would result in better health outcomes. Read more here.
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Psychiatric Drugs Haven't Improved for Decades. So Researchers Are Scouring the Brain for Leads
Katie first spoke with a demon when she was 14. He perched on the edge of her bed, and would persistently urge her to do bad things - like blow up her Arkansas high school.
She spoke to God, too.
Her parents, Pentecostal Christians, believed her visions made her special. So she received no therapy, and no medications, and no diagnosis as her schizoaffective disorder began to take root.
Katie, who is now 35, has been homeless and hospitalized several times. She tried "just about every drug there is," she said, before she found a medication - the antipsychotic risperidone - that works well for her. She's got a happy and stable life these days, living with her husband in Texas. But she knows it's tenuous.
"The thing is: A lot of times, a drug will work for you for several years, and then it'll just stop," said Katie, who asked that only her first name be used to protect her privacy. "At some point
I know I'll have to find another drug."
It's a common, and well justified, fear for people with psychiatric disorders. While scientists have made tremendous advances in decoding the genetics of physical illnesses, such as cancer, and developing precision therapies, treatments for mental health remain blunt tools. Read more
here.
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February 23, 12 - 1 pm
March 1, 10:30 am - 12 pm
March 1, 1:30 - 3:30 pm
OTHER TRAININGS
February 28, 1 - 2:30 pm, SAMHSA-HRSA
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Officers, Chairs & Regional Reps Call
March 1: 8 - 9 am, GTM
RPC Leads & Coordinators Call
March 9: 8 - 9 am,
GTM
Directors & Executive Committee Combined Meeting
March 15: 9:30 am - 12:30 pm, GTM
Children & Families Committee
March 21: 11:30 am - 1 pm, GTM
RPC Leads & Coordinators Call
March 23: 8 - 9 am,
GTM
Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422
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Transportation Innovations for New Yorkers with Disabilities Would Knock Down Barriers to Communities and Jobs, Says New PCG Study
A statewide, coordinated system for
transportation of individuals with disabilities could significantly improve their connections with jobs, community activities and overall quality of life, while delivering more efficient use of government and service-provider resources.
That is the key finding from a newly released report developed for the New York State Office for People with Developmental Disabilities (OPWDD) by Public Consulting Group, Inc., (PCG) a leading provider of management-consulting services to public-sector education, health, and human services clients, and subcontractor Nelson\Nygaard.
The report, "
Study to Design a Mobility Management Program,'' evaluated existing resources and systems for providing transportation to individuals with disabilities across New York's 62 counties. More than 1,000 direct service providers and transit providers were surveyed and interviewed.
PCG also evaluated human services transportation policies and practices in 11 states: Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Minnesota, New Mexico, Ohio, Utah, and Wisconsin.
PCG identified opportunities for New York to pioneer innovations in coordinating transportation for individuals with disabilities with a focus on jobs and community integration. Read more
here.
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Price Delays Rule Meant to Encourage Sharing of Substance Abuse Treatment Records
HHS Secretary Tom Price wants more public input before enforcing a rule that loosened privacy standards around substance abuse treatment records. The Obama administration issued the rule just weeks before President Barack Obama left office.
Price has moved the effective date of that rule from Feb. 17 to March 21.
The Trump
administration last month
imposed a 60-day freeze on new federal rules issued at the end of the Obama administration, pending their review by leaders of the new government.
Price, in a notice that will be published in the Federal Register on Thursday, said the prior effective date would not have allowed sufficient time for public comment. Read more here.
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Another Big Health Insurer Loosens Rules For Covering Addiction Treatment
Aetna, one of the nation's largest insurance companies, says that starting in March it will remove what's been a key barrier for patients seeking medication to treat their opioid addiction. The change will apply to all its private insurance plans, an Aetna spokeswoman confirmed. Aetna is the third major health insurer to announce such a switch in recent months.
Specifically, the company will stop requiring doctors to seek approval from the insurance company before they prescribe particular medications - such as Suboxone - that are used to ease withdrawal symptoms. The common insurance practice, called "prior authorization," has frustrated doctors because it sometimes results in delays of hours to days before a patient can get the needed treatment.
That delay may sound like just a technicality - a brief pause before treatment. But addiction specialists say this red tape has put people's ability to get well at risk. It gives them a window of time when they may change their minds or relapse if they start experiencing symptoms of withdrawal.
Aetna's policy change comes as addiction to heroin and opioid painkillers continues to sweep the country. More than 33,000 people
died from overdosing on these drugs in 2015, the most recent year for which statistics are available. Easing the prescribing restriction puts Aetna in the company of Anthem and Cigna, which also recently dropped the prior authorization requirement for their privately insured patients throughout the country. Anthem made the switch in January
and Cigna last fall
. Read more here.
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How Long You Stay On Opioids May Depend On The Doctor You See In the E.R.
Which doctor a person happens to see at a local emergency room can have long-term consequences when it comes to opioid use.
Within the same hospital, some doctors are three times more likely to prescribe an opioid than other doctors, and patients treated by high-prescribing doctors are more likely to become long-term opioid users, according to
a study published Wednesday in the New England Journal of Medicine.
"Physicians are just doing things all over the map," says Dr. Michael Barnett, an assistant professor at the Harvard T. H. Chan School of Public Health and one of the study's authors. "This is a call to arms for people to start paying a lot more attention to having a unified approach."
The study looked at how many opioid prescriptions emergency physicians gave to about 377,000 Medicare beneficiaries from 2008 through 2011. The lowest-prescribing quartile of doctors prescribed opioids to just 7 percent of patients, while the highest prescribed opioids to 24 percent - more than three times as often.
Patients who saw a high-intensity prescriber were about 30 percent more likely to end up with a long-term opioid prescription of at least six months within the year following their hospital visit. They were also more likely to return to the hospital in the next 12 months with an opioid-related fall or fracture, a risk factor for seniors who take the powerful painkillers. Read more
here.
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The Value Train Has Left The Station
"We are nothing without our provider partners."
That is a memorable phrase from the keynote address given last week by Brian Wheelan, Chief Strategy Officer and Executive Vice President, Beacon Health Options, at The 2017 OPEN MINDS
Performance Management Institute. Mr. Wheelan provided a great contextual review of the current value-based reimbursement environment in behavioral health and social services, and then shared the "scar tissue" from Beacon Health Options' first initiatives to move provider organization contracting to value-based arrangements.
His message - value-based reimbursement has developed more slowly in behavioral health than in the rest of health care, in part because of the historically low behavioral health spending in Medicare and the lack of a robust data set quantifying the benefit of these arrangements. But, that said, he thinks "the value train has left the station" and this shift to value-based arrangements will likely continue - regardless of changes in health care policy.
Beacon Options has made significant moves to shift their behavioral health provider network to value-based reimbursement. Currently, those initiatives represent less than 10% of claims paid.
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Value-Based Reimbursement & Accounting: Show Me The Money
"Accounting is the language of business, and you have to learn it like a language... To be successful at business, you have to understand the underlying financial values of the business." - Warren Buffett
Why are we talking about accounting?
Because we're seeing a collision of two worlds ahead - one that every executive team in health and human services needs to keep an eye one.
The first? An increasing number of value-based reimbursement models - pay-for-performance, pay-for-success, case rates, capitation, gainsharing - are changing how health and human service organizations are paid (for our most recent coverage of these changes, see
Tackling The Thorny Issue Of Behavioral Health 'Value' and
Medicaid MCO In Your State? There May Be An APM In Your Future).
The second is the application of new accounting standards to recognition of revenue from contracts with value-based reimbursement. In May 2014, the
Financial Accounting Standards Board (FASB), an independent, non-profit organization that "establishes financial accounting and reporting standards for public and private companies and not-for-profit organizations that follow Generally Accepted Accounting Principles (GAAP)," issued an Accounting Standards Update (ASU) 2014-09, Revenue from Contracts with Customers.
The goal of ASU 2014-09 is to update how revenue is recognized by organizations (see
New Revenue Recognition Accounting Standard-Learning and Implementation Plan). These standards are meant to apply across all industries - and will have significant implications for health care organizations - because the way many health and human service organizations earn and report revenue is changing. Read more
here.
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