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March 9, 2017

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

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Francine Sinkoff, Editor

Register Now: Behavioral Health Value Based Payment Feedback Sessions: NYS BH Investment Program 

New York State is planning to invest significantly in behavioral health providers to get ready for the transition to Value Based Payments. This event will serve as an opportunity to provide feedback to NYS OMH and OASAS staff regarding the investment program. 

MCTAC and state partners will provide an overview of t he NYS VBP initiative in this session. 

The sessions will be held on the following dates:

March 24: Rochester, 1-4 PM

Memorial Art Gallery

500 University Ave. 

Rochester, NY 14607

*Register here


March 27:  Long Island, 1-4 PM 

Melville Marriott
1350 Walt Whitman Road
Melville, NY 11747
*Register here


March 28: NYC, 9:30 AM - 12:30 PM 

Eisner & Lubin Auditorium
NYU Kimmel Center, 4th Floor
60 Washington Square South
New York, NY 10012
*Register here


April 12th: Albany, 1-4 PM 

Radisson Hotel Albany

205 Wolf Road

Albany, NY 12205
*Register here

People with Autism, Intellectual Disabilities Fight Bias in Transplants

Paul Corby needs a new heart. On that there is no dispute. The same rare disease that killed his father at 27 is destroying his left ventricle. While there is no cure or surgery that might repair the damage, a heart transplant could extend his life considerably.

But Corby, who lives in Pottsville, Pa., is autistic, suffers from several psychological conditions and takes 19 medications. When he applied to the transplant program at the University of Pennsylvania in 2011, he was rejected because of his "psychiatric issues, autism, the complexity of the process... and the unknown and unpredictable effect of steroids on behavior," according to the denial letter sent to his mother.

In fact, mentally disabled people are turned down for organ transplants often enough that their rights are a rapidly emerging ethical issue in this corner of medicine, where transplant teams have nearly full autonomy to make life-or-death decisions about who will receive scarce donor organs and who will be denied.  Read more here.
Rockland Pharmacies Must Take Back Unused Prescription Medication

Rockland County Executive Ed Day recently signed into law a bill that requires pharmacies to take back unused prescription medication.

He signed the bill at the Lexington Recovery Center, a mental health treatment organization that helps people with drug and alcohol addictions - including addiction to opioids.

"There is an epidemic of opioid abuse in this county, in this state, in this nation," the County Executive said. "We don't think it will happen in our family. We never think that those pills that the doctor prescribed for a mom or dad following surgery a couple years ago are could be misused."

The County Executive was also accompanied by Michael Leitzes, chairman of the Rockland Department of Mental Health; Ann Calajoe, director of chemical dependency services, Rockland Department of Mental Health and Barbara Tabala, director of Rockland County programming for Lexington.   Read more here .
Despite Increase in Treatments, Prevalence of Mental Health Issues Climbs 

A new study published in  World Psychiatry  discusses trends in treatment and prevalence of mood disorders across four countries: Australia, Canada, England, and the U.S. Results point to increases in the prevalence of mood disorders, even though each country has also had increases in treatment availability. The authors, each one based out of a different country, posit different theories as to why this occurs.

"All four countries have had increases in rates of treatment for these disorders since the 1990s... Despite these changes, none of the four countries had any evidence for a reduction in prevalence of disorders or symptoms over the period. If anything, there were indications of changes in the opposite direction in Australia, England and the US," wrote the authors.

Mental health issues, particularly mood disorders, are a common source of disability amongst developed countries. As the authors of this paper state, in order to close this "treatment gap" it has been suggested that treatment services need to be augmented. However, no other study has actually reported on whether this increase in services has led to a reduction in the prevalence of 'mental disorders.'   Read more here .
Outdated Privacy Law Limits Effective Substance Use Disorder Treatment:  The Case Against 42 CFR Part 2 

On November 17, 2016, Surgeon General Vivek Murphy released the first  report on substance use disorder (SUD) in the U.S. This landmark document described the tremendous toll of alcohol and drug use on the health and well-being of our nation. With the report, the Surgeon General issued a call to action, stating "how we respond to this crisis is a test for America." 

Highlighted in the recommendations was the need to address the segregation of SUD treatment outside of medical care and the need to fight persistent stigma. However, full implementation of these recommendations remains nearly impossible so long as the archaic federal privacy law known as  42 CFR part 2
remains in place.

Designed to protect stigmatized patients, ironically this added layer of protection now creates virtual care silos, hinders good medical care, and perpetuates stigma in the contemporary era of electronic health records (EHRs), health information exchanges, behavioral health integration, and HIPAA privacy protections.   Read more here .

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


MARCH 2017

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

APRIL 2017

Officers, Chairs & Regional Reps Call
April 5:  8 - 9 am

RPC Leads & Coordinators Call
April 6:  8 - 9 am,  GTM

Chemical Dependency Committee
April 7:  11:30 am - 12:30 pm,  GTM

Children & Families Committee
April 18:  11:30 am - 1 pm, GTM

Directors & Executive Committee Combined Meeting
April 19:  9:30 am - 12:30 pm, GTM

RPC Leads & Coordinators Call
April 20:  8 - 9 am,  GTM

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
CLMHD Legislative Update

On Wednesday's Senate Mental Health and Developmental Disabilities Committee Meeting agenda, there were three bills of major interest to the Conference. They included:

S.516 (Young)/A. 604 (Gunther)
Expands the Requirements of the AOT Program and Makes the Program Permanent

This bill or a similar version, which is strongly opposed by the Conference, has been in existence since 2010.   On March 8, the bill was reported to the Senate floor and is on First Reading. Click here to read t he Memo of Opposition issued by the Conference.

S.710 (Carlucci)/A. 524 (Gunther) 
AOT Program for Substance Abuse

This bill was first introduced in 2014 as part of the initial Senate bill package to combat the heroin and opioid epidemic. The bill attempts to apply the current AOT program for people with mental illness to individuals with substance use disorders. This bill is strongly opposed by the Conference.  On March 8, the bill was reported to the Senate Finance Committee.  Click here to read the Memo of Opposition issued by the Conference.

S.1912 (Ritchie)/A.3254 (Ortiz)
730 Chargeback Bill

This bill, which was introduced several years ago at the request of the Conference, would place a 30-day limit on the fiscal responsibility of counties to pay for services provided by state-operated mental hygiene facilities to restore to competency defendants held pursuant to a CPL 730  court order. This bill is known as the "chargeback bill".   On March 8, the bill was reported to the Senate Finance Committee.
Click here to read t he Memo of Support issued by the Conference.
NYS OASAS Announces $250,000 in Funding to Support New York Certified Recovery Peer Advocates

The New York State Office of Alcoholism and Substance Abuse Services (OASAS) today announced $250,000 in funding to support 500 certified recovery peer advocates across New York. This funding will help offset costs associated with becoming a Certified Recovery Peer Advocate, including the cost of renewing the certification for current advocates, to increase peer support services for individuals recovering from substance abuse.

As part of the Governor's ongoing efforts to increase support for New Yorkers recovering from substance abuse, this investment will help combat addiction and promote recovery in communities throughout the State. Funding will be available to offset costs associated with the certification application, examination fees, educational coursework, and internship opportunities.
Read more here.
UR School of Nursing Launches Redesigned Distance NP Program to Address Mental Health Needs 

In an effort to address critical shortages of mental health care providers in New York state and across the country, the University of Rochester School of Nursing has relaunched its  Family Psychiatric Mental Health Nurse Practitioner Program
(FPMHNP) as a distance program.

"By making this change, we are allowing students to stay in their home environments and continue working, while attending school and advancing their careers," said  Susan Blaakman, PhD, RN, NPP-BC, associate professor of clinical nursing and co-director of the FPMHNP program. 

According to a recent analysis by the U.S. Health Resources & Services Administration, the need for mental health care providers is expected to grow acute over the next decade. The shortage is especially critical in rural areas, where nurses generally do not have access to traditional graduate programs in their communities.  Read more here.
Governor Cuomo Announces Opening of First Recovery Community and Outreach Center in Long Island

Governor Andrew M. Cuomo last week announced the grand opening of THRIVE, the first addiction recovery community and outreach center on Long Island. The center, operated by Family and Children's Association in partnership with three other community nonprofits, will provide support for people in recovery from a substance use disorder and their families.  

THRIVE, also known as the center for Transformation, Healing, Recovery, Inspiration, Validation and Empowerment, will offer programs on education and vocational issues, health and wellness topics, and workshops on parenting and stress management, in addition to training sessions on how to become a Certified Recovery Peer Advocate. The center will also be made available to other recovery organizations to conduct meetings or to plan and hold events. Partnering organizations include the Long Island Recovery Association, Families in Support of Treatment, and the Long Island Council on Alcoholism and Drug Dependence.   Read more here .
PPS Provider Network Reopening

As part of activities relating to the midpoint of the DSRIP Program, the Department of Health is reopening the PPS Provider Network tool. This Network reopening will begin on March 15 and close on April 1, 2017, during this time PPSs will be able to add providers for inclusion in their DSRIP network. 

If your organization is interested in being included in a PPS network please reach out to your local PPS. PPS contact information is posted on the DSRIP website HERE.

Please send questions on Provider Network reopening to the DSRIP team via
Montefiore Health, University Hospital Score $400,000 to Integrate Mental Health Care Into Primary Care Practices 

Montefiore Health System and the University Hospital for Albert Einstein College of Medicine have been awarded grants that they hope will lead to  primary care physicians in small practices better support for treating common behavioral health conditions like anxiety and depression.

The two grants, one for $188,320 from the United Hospital Fund and one for $215,670 from the New York State Health Foundation, will allow Montefiore to support and evaluate a new mental health advancement guide it helped create called "Advancing Integration of Behavioral Health into Primary Care: A Continuum-Based Framework." The publication, which is available online, serve as a framework to help six primary care practices in NYC and another five elsewhere in the state implement and/or improve access to behavioral health services.  Read more here.
A Better Way to Treat Addiction in Jail 

As downward spirals go, Mark's was early and precipitous. He first tried alcohol at 13, began binge drinking shortly afterward, and graduated to pot, Percocet, then heroin. When he was 22, snorting drugs alone in a cheap motel room, he passed out on the floor, where he lay for hours in a position that cut off circulation to his right leg. It had to be amputated above the knee. While recovering in the hospital Mark had unfettered access to opiates, in severe pain but almost enjoying the little button on the morphine pump, he said. He went home with fistfuls of pills - Percocet, klonopin, morphine - and continued using until his mother finally called the police to report he was stealing from her.

For years Mark has been in and out of rehab and jail, each time returning home to the sick, panicky self-loathing it seemed only drugs could calm. Now, for the first time, he says, he's receiving effective treatment for his addiction - in jail. Serving 12 months for the theft, he's participating in the Rhode Island Department of Corrections' medication-assisted treatment program, the newest and most far-reaching of a handful of such programs around the country.

Ethics Survey: Behavioral Health 
Leaders Examine Industry Conduct

Federal raids on sober homes and addiction treatment centers in Florida in the past six months have resulted in 19 arrests and helped bring to light the prevalence of fraudulent and illegal activities within the state's profitable treatment industry. In most cases, investigators alleged patient brokering schemes, illegal kickbacks and identity theft.
And what's happening in Florida is happening in other markets around the country.

It's exceedingly difficult to quantify the scope of such unethical practices, but experts generally agree that it's more about criminal enterprise than treatment centers gone bad. For example, one operator  arrested in Florida for patient brokering in February had previously served a three-year jail sentence for defrauding the state's unemployment agency.

Behavioral Healthcare Executive surveyed our national audience of behavioral health professionals to get a better feel for their level of awareness regarding unethical practices and their opinions on what should be done to improve matters. More than 650 professionals responded to the first-ever BHE Ethics Survey.  Read more here .
Value Assessment Frameworks: How Can They Meet The Challenge?

Rising health care costs and pharmaceutical prices in particular are among the main factors that have prompted a steady flow of scholarly and lay press articles about moving from paying for volume to paying for value. Proposals from groups such as the  Center for American Progress advocate drug pricing based on assessments of comparative effectiveness.

If implemented, value-based assessments of drugs and other health care services would influence payer, provider, and patient decision making, and likely patient outcomes as well. Each of these approaches assumes that some calculus of value could reliably be measured, would apply to most patients and other stakeholders, and could inform health care decisions. As prior Health Affairs Blog posts have discussed, a variety of value assessment frameworks have been developed to compare the health and economic impacts of drugs and other interventions. Are these frameworks ready for the task? If not, what is needed?   Read more here .
Value-Based Reimbursement: 3 Steps To Go From Idea To Action

More and more of health care reimbursement to provider organizations is moving toward some type of value-based reimbursement. And, despite some pending changes in federal policy, it appears that the "train has left the station" with regard to value-based reimbursement (according to Brian Wheelan, chief strategy officer and executive vice president of Beacon Health Options - see  The Value Train Has Left The Station), and for health plans, there is no "Plan B" (according to Dr. Alan Muney, chief medical officer for Cigna - see  There Is No Plan B).

If your organization is going to prepare for the change to value-based reimbursement, then how do you understand what health plans want - and how do you get there? That was the focus of my closing remarks at The 2017 OPEN MINDS Performance Management Institute,  The Transition To Value: Addressing The Triple Challenge Of Performance Measurement, Talent & Capital. My advice to executive teams is to think about this in three stages: first, determine what health plans want that your organization can offer; second, develop a model with a "value equation" that works for your organization and the health plan; and lastly, address the infrastructure development issues that plague many provider organization executive teams as they move to value-based reimbursement.
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.