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June 8, 2016

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

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Francine Sinkoff, Editor

Supportive Housing Service and Operating Funding Availability

A new funding opportunity, the Empire State Supportive Housing Initiative, was announced today.  This funding will provide service and operating dollars forapproximately 1,200 units of permanent Supportive Housing.  Projects eligible for this program include Medicaid Redesign Team (MRT) populations. One objective of this RFP is to link capital projects to develop supportive housing with the Services and Operating funding of this RFP.

Proposals are due within 45 days and conditional award notifications will be made at the end of August. Funds awarded through the Empire State RFP will finance the operation and services provided by supportive housing; construction funding is availablethrough a number of other New York State and local capital funding programs and is not covered under this RFP.
Please click here for additional detail.
DOH Releases Global Cap Report

The New York State Department of Health (DOH) recently released its March 2016 Medicaid Global Spending Cap 
Report.  Click here for the report.
Understanding the New Medicaid Managed Care Final Rule

The final Medicaid managed care rule released on April 25, 2016 provides a comprehensive modernization of Medicaid managed care rules and regulations. For individuals working in the industry, there is a significant amount of new requirements and information to comprehend.

In an effort to help our clients and the Medicaid managed care industry understand specific topics in the final rule, the Milliman Medicaid Consulting Group recently released a series of papers that explore the specifics of the final rule for a number of topics.

The first paper addresses the final rule's treatment of "pass-through payments". Pass-through payments are the primary mechanism currently used to retain supplemental payment funding in managed care. Supplemental payment programs, sometimes called upper payment limit (UPL) programs, constitute a major source of revenue for providers in many states. The final rule confirmed that pass-through payments will be restricted in the near future and ultimately eliminated. This paper provides an overview of pass-through payment provisions in the new regulations, including the rationale and phase-out timing of the Centers for Medicare and Medicaid Services (CMS). The paper also discuss some of the difficulties the loss of pass-through payments will cause for states and providers and suggests a number of potential changes states can consider to mitigate the impact on managed care programs.

The second paper summarizes new regulatory requirements for Medicaid encounter data from the final rule, identifies best practices for state Medicaid agencies and managed care entities in the development and submission of encounter data, and envisions how improvements to Medicaid managed care encounter data quality may change the industry.

Federal financial participation (FFP) is not available for Medicaid services for individuals between the ages of 21 and 64 who are patients in an Institution for Mental Disease (IMD). This IMD exclusion is a long-standing component of Title XIX (Grants to States for Medical Assistance Programs) of the Social Security Act (Title XIX), which has recently come under scrutiny because of the combination of inpatient psychiatric capacity constraints and rapid enrollment growth of the Medicaid population. Our third paper on the final rule summarizes CMS' clarification of the use of IMDs as an "in lieu of" service.

--Paul Houchens, Principal and Consulting Actuary at Milliman



June 30, 1 - 2 pm

July 7, 1 - 2 pm

July 14, 1 - 2 pm
July 21, 1 - 2 pm

July 28, 1 - 2 pm

Other MCTAC Trainings:
June 22, 12 - 1 pm

June 30, 12 - 1 pm

August 24, 12 - 1 pm
September 21, 12 - 1 pm
October 26, 12 - 1 pm



JUNE 2016
Directors / Executive Committee Combined Meeting
June 21:  9:30 - 11:30 am
GTM Only

JULY 2016
Officers & Chairs - Call In
July 6:  8 - 9 am

Mental Hygiene Planning Committee
July 7:  11 am - 1 pm
GTM Only

Children & Families Committee
July 12:  11:30 am - 1 pm

Directors / Executive Committee Combined Meeting
July 26:  9:30 - 11:30 am
GTM Only

Developmental Disabilities Committee
July 27:  12 - 1 pm
GTM Only

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
New York State Launches Phase One of Unprecedented $10.4 Billion Homelessness Action Plan

Last week, New York State announced the launch of Phase One of the Homelessness Action Plan, which is part of a multifaceted, focused and comprehensive package of initiatives involving multiple agencies. In his 2016 State of the State address, Governor Andrew M. Cuomo proposed a historic $10.4 billion commitment to combat homelessness statewide over the next five years, which includes $2.6 billion for new supportive housing units and $7.8 billion for continuing commitments in support of existing supportive housing units, shelter beds, and other homeless services. 

In  remarks this morning at the Supportive Housing Network of New York State's annual conference, New York State Homes and Community Renewal Commissioner James S. Rubin outlined phase one of the Action Plan, which includes:
  • Issuing a Request for Proposals for 1,200 units of supportive housing. The RFP is the first phase of the $2.6 billion plan to develop 6,000 units of supportive housing over the next five years.
  • Addressing inadequate shelter housing in New York City by providing to the City of New York more than 500 beds in underused state and state-licensed facilities for the homeless.
  • Creating an Interagency Council on Homelessness to explore targeted solutions to homelessness and recommend best practices and policies to meet the ongoing needs of communities and individuals. 
  • Completing inspections of all 916 homeless shelters in the state and taking action to improve the conditions in homeless shelters so facilities are safe, clean and well-maintained.
Read more
here .
State Moves to Address Concerns Over Managed Care Switch for Developmentally Disabled

Meri Krassner has a 27-year-old son, Daniel, who lives at home. He was born with two holes in his heart, and suffers from developmental disabilities and scoliosis. He can't ever be left alone.

Daniel goes to a day program on weekdays, and on Saturdays, a community habilitation adviser comes to their New York City home to work with him one-on-one. He spends some weekends in an away program to allow his parents time to rest, and he goes to a summer camp for 11 days each year. The facets of Daniel's extensive care program have been stitched together by his family, and all of the services he receives are available through the state's Office for People with Developmental Disabilities.

As part of the state's Medicaid overhaul, the OPWDD, which serves about 130,000 individuals in New York, will soon transition to managed care, and despite efforts from the state to quell anxieties, Krassner and other other parents fear that the shift might mean that the systems they have carefully designed for their children could come apart at the seams.

"If you look at the rollout [of managed care] and how it's happened in other states, there is cause for concern," said Annette Downey, the executive director of Oakland's Community Living Services, a care provider for people with intellectual and developmental disabilities in Michigan.

Michigan made the transition to managed care in 1998, and Downey said hopes that New York will look to the states that have made the transition and learn from them.
New York will become the eighth state to implement managed care for developmentally disabled adults, and while some states, like Michigan, have had great success, others have seen providers go unpaid, insurers lose money, and care delivery lag. In Kansas, there was even concern that insurers would pull out of the market entirely because of problems with managed care, which would have caused extreme delays in care.  Read more here.
OPWDD Announces Centers of Excellence in the Care and Treatment of Children with Complex Disabilities

The Office for People With Developmental Disabilities (OPWDD) last week announced a partnership between three not-for-profit agencies, The Center for Discovery (TCFD), Developmental Disabilities Institute (DDI), and Upstate Cerebral Palsy (Upstate CP), in the creation of the Centers of Excellence which will address the care and treatment of children with complex disabilities, such as autism and other neurodevelopmental conditions. This partnership is made possible through an award of federal Balancing Incentive Program (BIP) funding administered through OPWDD, in coordination with the New York State Education Department and the New York State Department of Health.

The goals of the Centers of Excellence are to launch an intense and coordinated effort aimed at identifying best practices for intervention, conducting research, and developing new treatments and strategies to support children with autism and other neurodevelopmental disorders in the most integrated setting. The three separate Centers of Excellence will benefit from the collective intelligence and insights of each member organization and, in turn, work with New York State agencies and other providers.  

"Now that we are better able to identify children and families who need support, we need to better address the supports and systems available and make sure we are better able to meet their complex needs," said Kerry Delaney, Acting Commissioner of the NYS OPWDD. Read more here.
Mental Health Council Issues 150 Day Update on ThriveNYC

The Mental Health Council, established b y
ThriveNYC  and led by First Lady Chirlane McCray and Deputy Mayor Richard Buery, today released an update on the progress of ThriveNYC programs. ThriveNYC is the action plan to begin changing the way people think about mental health and substance misuse and to improve access to services launched by First Lady McCray in November. The City is investing $850 million in this work over the next four years.
Highlights of the update include:
  • 29 hospitals responsible for 78 percent of newborn deliveries in NYC annually have committed to screen all mothers in their care for maternal depression.
  • More than 2,300 New Yorkers trained in how to identify signs and symptoms of mental illness, respond in a crisis, and connect people to treatment.
  • 2,500 NYPD officers trained in Crisis Intervention Training, which provides officer the tools and knowledge they need to de-escalate crisis situations and respond to challenges related to mental health, substance misuse and other disabilities.
  • 263 young people in foster care and 243 foster care parents and staff have participated in workshops that teach healthy relationship skills.

The full report can be accessed here.

Details On Death Certificates Offer Layers Of Clues To Opioid Epidemic

Dr. James Gill walked through the morgue in Farmington, Connecticut, recently, past the dock where the bodies come in, past the tissue donations area, and stopped outside the autopsy room.

"We kind of have a typical board listing all of the decedents for the day," Gill said, pointing to the list of names on a dry erase board. "Overdose, overdose, overdose, overdose overdose. That's just for today."

Gill is the  chief medical examiner for the state of Connecticut, and of the nine bodies in his custody that day, four were the remains of the people who likely died from an accidental drug overdose. A fifth was a probable suicide involving drugs. It was a sad, but typical day, he explained, with a practical consequence for the state's morgue: Gill is running out of room to store bodies.

"We've had to buy some extra racks and things so we can store more," he told me. "But we really probably need more cooler space. We're kind of outgrowing the storage space here."

In the past two years, Gill's office has seen a more than a 50 percent increase in autopsies. That's mostly because of the spike in accidental drug overdoses, he said. Heroin is the big player. Fentanyl deaths have surged, too.  Read more here .
Long-Acting Opioid Treatment Could Be Available In A Month

Labels for the first long-acting opioid addiction treatment device are rolling off printing machines Friday. Trainings begin Saturday for doctors who want to learn to insert four matchstick-size rods under the skin. They contain the drug buprenorphine, which staves off opioid cravings.

The implant, called Probuphine, was  approved by the Food and Drug Administration on Thursday, and is expected to be available to patients by the end of June.

But debate continues about how effective the implant will be and whether insurers will cover it.   Nora Volkow, head of the National Institute on Drug Abuse, calls Probuphine a  game changer , saying it will help addiction patients stay on their meds while their brain circuits recover from the ravages of drug use.

And addiction experts say it will be much harder for patients prescribed the implant to sell their medication on the street, which can be a problem with addiction patients prescribed pills.  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.