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October 26, 2016

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

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Francine Sinkoff, Editor

BJA Launches Police-Mental Health Collaboration Toolkit 

The U.S. Department of Justice's Bureau of Justice Assistance (BJA) launched an online toolkit Monday that supports law enforcement agencies around the country in planning and implementing effective calls for service involving people with mental illnesses.

Highlighting the role of police departments in advancing these approaches, BJA announced the  Police-Mental Health Collaboration (PMHC) Toolkit at the 2016  International Association of Chiefs of Police Conference in San Diego, California.
The PMHC Toolkit was developed in partnership with The Council of State Governments (CSG) Justice Center and gathers best practices and resources to help law enforcement agencies partner with mental health providers when responding to calls for service involving people with mental illnesses.

The PMHC Toolkit outlines the overall benefits of PMHC programs in five sections: learning about PMHC programs; planning and implementing; training; managing; and measuring.  Read more here.
A.G. Schneiderman Announces National Settlement With Cigna To Discontinue Pre-Authorization For Opioid Addiction Treatment Drugs

Attorney General Eric T. Schneiderman recently announced that Cigna, a major global health insurer, will end its policy of requiring prior authorization for medication-assisted treatment ("MAT") for opioid use disorder. Cigna's change comes just months after Attorney General Schneiderman requested that the company provide information about its MAT policies to address concerns about barriers to treatment for opioid use disorder.  Preauthorization requirements can lead to delays - sometimes significant -- in patients obtaining treatment for addiction.

MAT, when prescribed and monitored properly, has proved effective in helping patients recover from opioid use disorder, and is both safe and cost-effective to reduce the risk of overdose. This policy change will apply not only to most members in New York, but nationally as well. 

Cigna required providers to submit a prior approval form for MAT requests, which required the providers -- who had already received specific training regarding MAT in order to prescribe these drugs -- to answer numerous questions about the patient's current treatment and medication history. Authorization in some instances took several days.   Read more here .
How to Comply With New DOL Overtime Rules

On December 1,  new rules for calculating overtime issued by the U.S. Department of Labor (DOL) go into effect. Behavioral healthcare organizations could see unexpectedly higher overtime costs or even potential fines if they do not comply.

The key element of new DOL rules-and one that is likely to be particularly significant for behavioral healthcare organizations-is a much higher salary threshold that defines which employees are eligible to be paid for overtime. A higher salary benchmark means more workers will fall under the nonexempt status, meaning they are eligible for overtime pay.

In the past, employees who earned a salary of $455 per week ($23,660 per year) or more could be classified as exempt-not eligible for overtime pay. The new rules increase the salary for the exempt classification significantly to $913 per week ($47,476 per year), a level that will be adjusted for inflation periodically.

For some treatment center operations, the new overtime rules could translate into higher payroll costs as more employees clock in extra time beyond the benchmark 40 hours per week.

"There is probably going to be a pretty high rate of noncompliance [among behavioral healthcare organizations] with people continuing to work long shifts without getting paid overtime and exposing facilities to penalties," says Harry Nelson, managing partner with Nelson Hardiman LLP, a healthcare law firm based in Los Angeles. Read more here.
New York Providers Target Emergency 'Super Utilizers' to Coordinate, Reduce Hospital Visits

Some frequent visitors to the emergency departments at Sisters of Charity Hospital and Mercy Hospital in Buffalo have begun receiving follow-up calls as the hospitals launch an effort to coordinate patient care to reduce repeat visits for ailments that may not be truly urgent.

Community Partners of WNY, a Performing Provider System, began the call-back program this week at two of its busiest emergency departments, said Scott Kitchen, vice president of clinical and business intelligence at the PPS.

The concept is simple: Identify and contact frequent ER visitors who are either on Medicaid or enrolled in a Medicaid HMO and match them up with primary care providers or health homes to reduce future, avoidable hospital visits.

"Believe it or not, we have patients who are in such dire need of coordinated health care. They've been in the ER literally a dozen times in a month and that's just not right for anybody," Kitchen said. "We've really worked to try to find a way to help these patients and ... provide them the care they need in the appropriate setting that's very connected."   Read more here .
'Watching the Ship Sink': Why Primary Care Doctors Have Stayed Out of the Fight Against Opioids

Española , N.M. - For years, this town has withstood a torrent of  opioid-related deaths , and now claims one of the highest rates of opioid overdoses in the country.

But the battle against opioids in Española is being fought with a paltry force: In a community of roughly 10,000, only three physicians are certified to treat patients with opioid use disorders.

The scarcity of doctors trained to deal with addiction may be particularly acute in Española, but the issue resonates in cities and towns across the country, where roughly 20,000 people die annually from opioid-related overdoses. In the face of one of the country's most pressing and fastest-growing public health crises, few primary care doctors treat substance abuse disorders, even though they are uniquely positioned to recognize problems and help patients before it's too late.

Instead, many primary care doctors follow an old script: Refer patients to addiction centers and Narcotics Anonymous, and move on. 
Read more here .



November 2, 2 - 3 pm

November 15, 12 - 1 pm




RPC Advisory Committee 
October 27:  8 am
GTM Only


Officers & Chairs - Call In
November 2:  8 - 9 am

RPC Advisory Committee 
November 10:  8 am
GTM Only


Mental Hygiene Planning Committee
December 1:  11 am - 2 pm
In-Person Meeting

Officers & Chairs - Call In
December 7:  8 am

RPC Advisory Committee 
December 8:  8 am
GTM Only

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

Directors/Executive Committee
December 20:  9:30 - 11:30 am
GTM Only

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
Joseph A. Todora, MSW, LMSW, Announced New Chair of CLMHD
We are pleased to announce Joseph A. Todora, MSW, LMSW (Sullivan County), as the new Chair of the NYS Conference of Local Mental Hygiene Directors. Most recently, Joe served as First-Vice Chair of the Conference and assumes the role of Chair this week replacing Scott LaVigne (Seneca County) who has accepted a new position out of state.  

Joe is the Director of Community Services (DCS) for Sullivan County and is also the Commissioner of the Sullivan County Division of Health & Family Services. As such, he is one of five DCSs in the state with the dual roles as DCS and Department of Social Services Commissioner.
In addition to his leadership positions in the Conference, Joe is a member of the Conference's Finance Committee and the Mental Hygiene Planning Committee and serves as Chairman of the New York State Association of Counties (NYSAC) standing Public Health/Mental Health Resolutions Committee. Joe has been equally involved in his community as a Monticello School Board member for three years and as a Board Member on the Sullivan County Board of Cooperative Educational Services (BOCES).  
Prior to his role as DCS, Joe worked in numerous roles within the Sullivan County Department of Community Services including Coordinator of OMRDD, DAAA and DSAS and in the County's Public Health Department as Early Intervention/
Preschool Handicapped Children Services Coordinator.  He also served as a counselor and administrator at the Onondaga Pastoral Counseling Center.  
Joe earned his undergraduate degree at SUNY Cortland where he majored in Physical Education with a near double major in Psychology. He went on to Syracuse University to receive his Master's in Social Work degree.
The Conference welcomes Joe to his new role and looks forward to his leadership during this time of change and the transformation of the behavioral healthcare system in New York State.
Governor Cuomo Announces Action to Ensure Health Insurers Provide Coverage for Necessary Substance Abuse Treatment

Governor Andrew M. Cuomo last week announced that the Department of Financial Services has issued  guidance to health insurers outlining new insurance coverage requirements for substance abuse treatment. The action follows landmark
legislation  signed by the Governor earlier th is year to combat the heroin and opioid crisis in New York State. 

Under the new law, health insurers will be required to cover medication, including naloxone, for detoxification or maintenance treatment of substance use disorders under large group policies. This new requirement mirrors the coverage requirements for individual and small group policies. Health insurers will also be required to provide coverage without preauthorization for inpatient substance abuse treatment in facilities that participate in their networks and are certified by the New York State Office of Alcoholism and Substance Abuse Services.

The new guidance alerts health insurers that they must provide inpatient and outpatient coverage for detoxification and maintenance treatment medication, including naloxone. It also instructs health insurers that they must eliminate prior authorization requirements for a five-day emergency supply of prescribed medications for the treatment of substance use disorder when an emergency arises. The guidance by DFS outlines insurer utilization review requirements, and includes time-frames under which the utilization review determinations must be made by health insurers.   Read more here .
1115 Demonstration - New York Partnership Plan

New York submitted a request to amend its 1115 demonstration to provide limited transitional coverage for services to incarcerated individuals who are enrolled in Medicaid for the 30 days prior to release from jail or prison. The state's goal is to decrease emergency department visits, hospitalizations, overdoses, and recidivism for recently released offenders who have two or more chronic diseases, HIV/AIDS, or a serious mental illness. The federal comment period will be open from October 21, 2016 through November 20, 2016.

Click here to view the pending application.
To view and/or submit public comments, click here.
Governor Cuomo Announces Nearly $21.6 Million for Eight Supportive Housing Projects

Governor Andrew M. Cuomo recently announced nearly $21.6 million has been awarded for eight supportive housing projects that will create a total of 265 units for homeless New Yorkers. The awards, made through the New York State's Homeless Housing and Assistance Program, will fund supportive housing projects in Suffolk and Oneida counties for homeless veterans and their families, as well as ones in New York City, Erie, Nassau and Oneida Counties for homeless individuals and families. All eight projects are part of Governor Cuomo's historic $10 billion commitment to building affordable housing and combating homelessness.

Of the 265 supportive housing units being created, 141 will be permanent and transitional supportive housing in New York City, Erie, Nassau, Oneida and Suffolk Counties. The units will serve vulnerable individuals with special needs, and will include a variety of supportive services tailored to their needs such as employment training, counseling, independent living skills training, benefits advocacy and assistance in obtaining and maintaining primary and mental healthcare.  Read more here .
NYS DSRIP Whiteboard - An Eye toward the Future

Published on October 17th, this presentation by New York State's Medicaid Director, Jason Helgerson, talks about what we see beyond the goals of DSRIP and beyond the goals of trying to achieve a more cost-effective health care delivery system. The video also describes how the health care sector can collaborate with other similar systems to improve the health, well-being, and the happiness of the communities in which we serve.
Mental Health America Report: More Than Half of Mentally Ill U.S. Adults Get No Treatment

Mental Health America just released its  annual assessment  of Americans with mental illness, the treatment they receive and the resources available to them - and the conclusions are sobering: Twenty percent of adults (43.7 million people) have a mental health condition, and more than half of them do not receive treatment. Among youth, the rates of depression are rising, but 80 percent of children and adolescents get either insufficient treatment or none at all.

"Once again, our report shows that too many Americans are suffering and far too many are not receiving the treatment they need to live healthy and productive lives," Paul Gionfriddo, president of Mental Health America, said in a statement. "We must improve access to care and treatments, and we need to put a premium on early identification and early intervention for everyone with mental health concerns."

The national community-based nonprofit
ranked all 50 states and the District of Columbia on 15 measures, including adults with any mental illness, youth with at least one major depressive episode in the past year, and the availability of mental-health workers. Even though more Americans are insured, the report found a dire need for adequate treatment, especially in the Deep South.   Read more here .
PWC Report: Health Care Teams Cut Costs for Chronic Illness

Health care organizations can cut costs by $1.2 million per 10,000 patients by using a health care team to manage chronic illnesses, according to a new report from PricewaterhouseCoopers' Health Research Institute. The researchers concluded the savings would come mostly through reduced hospitalizations and ER visits. To capture any of that money, though, providers must enter into shared-savings arrangements with insurers. Adding new types of workers to a practice's staff-such as dietitians, mental health professionals and social workers-will help the practice manage and prevent disease, which is key to the shift toward value-based payment.

Many physicians are spending an inordinate amount of time on administrative work and addressing patients' social barriers to care-tasks that PwC believes can be shifted to nonphysicians. Instead, primary care physicians will spend more time "designing care plans and addressing patients' complex medical issues," the report said. The consulting firm recommends that practices divide patients into certain categories, such as those with multiple chronic conditions or a mental health condition, and tailor teams to meet their needs.  Read more here.
New Mental-Health Hotline Opens in New York City

New Yorkers in need of emergency mental-health counseling can now seek help by phone, text or chat through a hotline that is staffed around the clock.

The new program, called NYC Well, will offer short-term help to New Yorkers struggling with suicidal thoughts, mental-health problems and substance abuse. The hotline, which started Monday, is open 24 hours a day, 365 days a year.

The new plan is part of the so-called Thrive NYC initiative, which aims to destigmatize mental illness and make mental-health care more accessible. The new hotline will also provide mobile crisis teams when care is needed inside a home.  Read more here.
Getting Dental Care Can Be A Challenge For People With Disabilities

At the Marshfield Clinic  dental center in Chippewa Falls, Wis., hygienist Karen Aslinger is getting her room ready. It's all quite routine - covering the chair's headrest with plastic, opening instruments, wiping down trays.

But then she starts getting creative.
"My next patient is pretty tiny and frail, so I like to go to oral surgery and get a heated blanket. I wrap her up, and I think it soothes her," Aslinger says.

The patient is 16-year-old Kathy Falk. She suffers from  Rett syndrome, which is a genetic disorder with a constellation of symptoms that look like cerebral palsy, Parkinson's, anxiety and autism all wrapped up together. She uses a wheelchair, can't speak and would find it difficult holding her mouth open for long stretches.

Kathy's parents lift her from her wheelchair into the dental chair. Aslinger swaddles her in the warmed blanket and fits her with tiger-striped sunglasses to block the glaring light. She narrates the entire cleaning, telling Kathy everything she's about to do, interspersed with words of encouragement.

For someone with severe disabilities like Kathy, Aslinger and this clinic are quite a find. They welcome patients with all kinds of physical and behavioral disabilities. 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.