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March 23, 2017

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

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Francine Sinkoff, Editor

OMH Releases 2016 - 2020 Statewide Comprehensive Plan

OMH has released its Statewide Comprehensive Five-Year Plan for 2016-2020. This report is also known as the "5.07 Plan", after section 5.07 of NYS mental hygiene law. The Plan includes a review of consumers, services and programs, and gross expenditures within the New York State public mental health system. The 5.07 Plan also reviews several top priorities for OMH policy and planning efforts in the current and upcoming years.

Click here to view the statewide plan.
Who Are the 7 Million Nonelderly Adults with Disabilities in Medicaid and What Would the Restructuring of Medicaid Financing and Repeal of the Affordable Care Act Mean for Them?

A new brief from the Kaiser Family Foundation explains the role that Medicaid plays for nearly 7 million nonelderly adults with disabilities in the U.S. and explores what the American Health Care Act could mean for their health care and coverage.

Medicaid covers more than three in 10 nonelderly adults with disabilities, including people with physical disabilities, such as cerebral palsy, multiple sclerosis, and traumatic brain or spinal cord injuries; intellectual or developmental disabilities such as Down syndrome and autism; and mental illness. Over half who are enrolled in Medicaid live below the federal poverty level. They are four times as likely to receive nursing or other health care at home, and more than 1.5 times as likely to have 10 or more health care visits in a year compared to those with private insurance.

Through Medicaid, nonelderly adults with disabilities have access to regular preventive care as well as medical care for illnesses and chronic conditions.  States must provide certain minimum services for adults, such as inpatient and outpatient hospital, physician, lab and x-ray, and nursing home services.  States also can choose to provide a broad range of optional services such as prescription drugs, physical therapy, private duty nursing, personal care, rehabilitative services, and case management.  Read more here.
PPS Mid-Point Assessment Action Plans

In response to the final DSRIP Mid-Point Assessment Recommendations, as voted upon by the Project Approval and Oversight Panel (PAOP), the PPS were required to submit Mid-Point Assessment Action Plans to the Independent Assessor (IA) by March 10, 2017. Three (3) PPS, Community Care of Brooklyn PPS, Staten Island PPS and New York Presbyterian/Queens PPS, did not have any recommendations and therefore do not have action plans. 

These action plans are now posted to the DSRIP website here for review.   The action plans can be found at the bottom of each individual PPS section.
The action plans will be open for a public comment period from Monday March 20, 2017 through Friday March 31, 2017. During this period, any comments regarding the PPS action plans can be sent to
PPS Provider Network Now Open

As part of activities relating to the midpoint of the DSRIP Program, the DSRIP PPS Provider Network is now open. PPS will be able to add providers for inclusion in their DSRIP network until the network closes on April 1, 2017. 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 under the heading "PPS Information."  Please send questions on Provider Network reopening to the DSRIP team via  
Stat: 'This Pain Has Gone Too Far': Family's Search For A Drug Treatment Bed Is Hauntingly Common Story In U.S.

HUNTINGTON, W.Va. - The white car had stopped in the middle of the highway. The driver was slumped behind the wheel, her breaths faint and few.

Her head was bobbing, chin to chest; her pupils were the size of a pinpoint. The car was strewn with syringes. Paramedics inserted a needle of  naloxone, an opioid antidote, into her left arm - the one with fewer scars. A minute passed. Two. At last, Taylor Wilson's eyes flickered opened below the bright ambulance lights.

Taylor's overdose was the first of 28 that would be reported in this small city on the Ohio River in the span of five hours on Aug. 15, 2016. Frantic calls flooded in to 911: Heroin users were passed out on dining room floors and in convenience store bathrooms. "People are coming here and dying," one caller said. The horror of that afternoon made  national news: CNN, Fox News, Associated Press, the Los Angeles Times.

Then the reporters left. Taylor's story, though, was just beginning.   Read more here .
SAMHDA Launches Improved Public-use Data Analysis System

The Substance Abuse and Mental Health Data Archive (SAMHDA) has made significant improvements to the Public-use Data Analysis System (PDAS) . Through this system, you can perform online analyses to create crosstabs and perform logistic regression from your web browser. You can also download output and underlying data in .csv format. Upgrades to PDAS include state data for the National Survey on Drug Use and Health Small Area Estimate, mapping and visualization tools, and an enhanced user interface. You are invited to try out PDAS and explore the spectrum of available public use files.  
Point of Health Podcast: 
Addressing the Opioid Epidemic from a Health Plan Perspective

Point of Health Edition #4 features Patricia Hunter, Behavioral Health Manager of BlueCross BlueShield of Western New York, and focuses on how to address the nation's growing opioid crisis. 

Click HERE to listen.

About the Podcast Series:
Point of Health is a BlueCross BlueShield of Western New York free audiocast. This series keeps you updated on key topics and issues in the rapidly changing health care industry. Each edition will feature an interview with experts on health insurance and health care, covering a variety of perspectives and providing information for listeners.


March 27, 2 - 3:30 pm, SAMHSA

March 29, 12 - 12:30 pm, National Council

March 29, 1 - 2 pm, National Council

March 29, 2 - 3:30 pm, National Council

March 30, 2 - 3:30 pm, SAMHSA GAINS Center

April 26, 2 - 3:30 pm, SAMHSA

May 17, 3 - 4:30 pm, Rural Behavioral Health

Responding to Natural Disasters in Rural Communities
June 21, 3 - 4:30 pm, Rural Behavioral Health

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


APRIL 2017

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

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

Mental Health Committee
April 6, 11 am - 12:30 pm, GTM

Chemical Dependency Committee
April 7:  11 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 
11 Behavioral Health Advocacy Groups Urge Albany to Address the Community Care Crisis

On Tuesday, CLMHD Executive Director, Kelly Hansen, joined representatives of 10 other behavioral health advocacy groups, to meet with state legislative leaders to urge support of funding for a workforce increase and cost of living adjustment (COLA) to address the crisis in New York's community-based behavioral health services.
Advocates included the Association for Community Living, Coalition for Behavioral Health Agencies, Families Together in NYS, Mental Health Association in New York  State, National Alliance on Mental Illness-NYS, New York Association of Alcoholism and Substance Abuse Providers, New York Association of Psychiatric Rehabilitation Services, NYS Coalition for Children's Behavioral Health, NYS Conference of Local Mental Hygiene Directors, NYS Council for Community Behavioral Healthcare and the Supportive Housing Network of New York.
Many thanks to Senator Rob Ortt, Chair of the Senate Mental Health and Developmental Disabilities Committee, for his commitment to the Behavioral Health sector.
Stabilization Center Brings Resources, Second Chances to Dutchess County

Pictured:  County Executive Marc Molinaro, Dr. Kenneth M. Glatt

Dealing with suicidal ideations, a young man, along with his father, came to Dutchess County's new Stabilization Center looking for help.

"He had a plan, and he had means," said Beth Alter, director of the Office of Community Services in the county's Department of Behavioral and Community Health. "But they came here because they knew somebody who heard about this."

After an evaluation at the center, it was determined the best thing for the man was to seek further medical attention, and the faculty explained to the family the process of being admitted to the hospital.

"The father called back to say thank you, and that 'we didn't know what our whole experience would have been like, if we had gone to the hospital first,'" Alter said.

The Stabilization Center, which officially opened last month, serves as a voluntary walk-in or police drop-off for individuals suffering from mental illness or substance abuse. Those who visit the center, referred to as guests, stay for a 23-hour period and are offered a variety of services, with access to a full-time nursing staff from MidHudson Regional Hospital of Westchester Medical Center.

At the center's grand opening Thursday, Dutchess County Executive Marc Molinaro said strides need to be made in the way society treats mental illness and confronts addiction. Members of MidHudson Regional Hospital, Astor Services for Children & Families, Mid-Hudson Addiction Recover Centers, and PEOPLe,  Inc.were also in attendance to discuss the  
transformation of the 23,000-square-foot space.   Read more here .
MHA National Certified Peer Specialist Certification - Get Certified!

The MHA National Certified Peer Specialist (MHA NCPS) certification recognizes peers with the lived experience, training, and job experience to work alongside healthcare teams. The certification is designed to exceed the standards used in public behavioral health around the country. A major purpose of the certification is to meet the needs of private health insurers and private practitioners. Expansion of peer support into the private sector will open up new career paths and opportunities, which have been previously unexplored, for thousands of peer supporters.  For more information, click here.
Youth Mental Health Services in Central NY Fall Short, Elected Officials Say

A youth mental health task force has identified some of the largest gaps in mental health services in central New York. The lawmakers who launched the study say they will now look for ways to fill those gaps.

Rep. John Katko (R-Camillus) and Assemblyman Bill Magnarelli (D-Syracuse) joined forces to get the facts about where local mental health services are falling short for central New York youth. The report reveals a number of needs, for things like better crisis management, earlier diagnosis, and increased access to services. Katko says much of the reason mental health issues stay under the radar is the stigma attached to these illnesses.

"We talk about cancer, and every time a new cancer drug is out it's like nirvana, which it is. But we don't talk anything about mental health. And we have to. We have to do it because it will literally save lives," Katko said.

Going forward, Katko says he'll work on the federal level to overcome some of these barriers, including things like incentivizing healthcare providers to pursue careers in mental health care.  Read more here.
Out of Sight, Out of Mind - Behavioral and Developmental Care for Rural Children

The Centers for Disease Control and Prevention (CDC) has just offered further evidence that American children - and rural children in particular - are in trouble. Previously, the CDC had noted that poor U.S. children 2 to 8 years of age have higher rates of parent-reported mental, behavioral, and developmental disorders (MBDDs) than their wealthier counterparts. Now, in the latest of a series of reports, the agency documents the finding that rural children from small communities are more likely to have MBDDs than those living in cities and suburbs.

What might cause this disparity? One important factor is that rural children often live in poverty, the severity of which is increasing. According to the U.S. Department of Agriculture, about one in four rural children in the United States lives in poverty, as compared with one in five children nationwide.  Poverty harms the developing brain through both biologic and social effects. 3  One pathway from poverty to MBDDs may be parental alcohol and drug use, which is associated with lower birth weight and developmental delay in offspring and risk for behavioral disorders in childhood. (Causation could also run reciprocally from MBDDs to poverty: families coping with children with such disorders can lose income and incur increased out-of-pocket costs.)
Read more here.
Visualized: What Medicaid Pays for Addiction Treatment Meds, State by State

As Republicans plan to  overhaul Medicaid , the opioid crisis looms large.   More than 30,000 Americans are dying from heroin and painkiller overdoses every year. Hundreds of thousands of people covered by Obamacare's expansion of Medicaid - more than a million, by  at least one estimate  - have mental health and substance abuse issues.

The GOP plan could impact the program in two ways. First, it  would eliminate in 2020 the requirement that states, which administer Medicaid and jointly fund it with the federal government, offer robust coverage of mental health and substance abuse services for people who enrolled in Medicaid under the Obamacare expansion. According to the  Kaiser Family Foundation, traditional Medicaid coverage of these services is often less generous than the expansion coverage. So the fear is that coverage for those people would be rolled back under the GOP's plan.

Second, it would fundamentally change how the entire program, which covers more than 70 million people, is funded. Instead of an open-ended federal commitment to pay whatever is necessary, states would receive a set dollar amount from the feds for each person. In exchange, states are supposed to receive more flexibility - even if the Republican bill doesn't do much to provide it. The Heath and Human Services secretary, Tom Price,  has pledged , however, to use his administrative authority to give states that leeway.  Read more here.
The House Manager's Medicaid Amendments: The State Block Grant Option 

The 1995 Medicaid  block grant provisions
contained in the Balanced Budget Act of 1995 that was sent to (and vetoed by) President Clinton consumed 100 pages of dense legislative drafting. The block grant provisions of the  American Health Care Act  (AHCA)-which faces an imminent vote on the House floor-are much more efficient, taking up about eight pages in the House Manager's Amendment (Policy Changes).

Read in some detail-although there is not much detail to read-the block grant option can be read as an astonishing expression of legislative policy, and even more so perhaps, a statement of child health policy. The lax nature of the amendment can be seen in the lack of federal integrity controls over hundreds of billions of dollars in federal spending. And the public health implications of the amendment can be seen in the degree to which the provision would-as a statement of general federal policy-move the role of government away from ensuring access to adequate health care for its very poorest residents, who, under the amendment's terms, disproportionately are infants and children.

Titled "Flexible Block Grant Option for States," the amendment adds a coda of sorts to the  bill's new Medicaid per capita cap payment system. Under the amendment, states would have an option to receive a certain portion of their federal Medicaid funding in the form of a block grant. A state would opt for the block grant model on a 10-year basis and would qualify for block grant funds simply by filing a state 10-year plan with the HHS Secretary; the state's plan would be deemed approved if the agency fails to stop the clock within a 30-day window because the proposed plan is either "incomplete" or "actuarially unsound."
Read more here .
Your Tech Functionality Checklist For Value-Based Reimbursement

The shift to value-based care has turned "business as usual" on its head for many health and human service provider organizations. It's forced the executive teams at those organizations to operate while simultaneously using a growing percentage of value-based payments in a fee-for-service environment, and do so while shifting their strategy to population health (see  Where Are Behavioral Health & Social Service Organizations With Value-Based Reimbursement? The Numbers Are In). And the key to making the most from diminishing margins is tracking quality measures - and to do that before payers ask.

There are seven key infrastructure competencies every provider organization should have to track quality in services and operations:
  1. Capacity to Collect Data: What population does your organization serve, and what are their health needs? The fundamental competencies needed to answer "yes" are a fully implemented electronic health record (EHR); structured data collection around assessments, diagnoses, and services; workflows and processes to ensure data integrity; and the ability to collect data at the time and source of service provision (see From Data Modeling To Data-Driven Decisions).
  2. Capacity to Analyze Data for Population Health Management: Do you have the ability to perform strategic analysis of data for risk stratification and care management? The fundamental competencies needed to answer "yes" are the ability to develop or access consumer data registries; develop analysis tools; implement risk stratification strategies; and integrate multiple sources of data (see Can Data Fix It?).
  3. Ability to Manage Value-Based ContractsRead 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.