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December 8, 2016

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

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Francine Sinkoff, Editor

September 2016 CMS Medicaid & CHIP Eligibility and Enrollment Report

According to CMS's most recent monthly Medicaid/C HIP eligibility and enrollment
report, 73,141,300  m illion individuals were enrolled in Medicaid and CHIP in September 2016. Nearly 21,114  additional individuals enrolled in Medicaid and CHIP since August 2016. Click  here  to access the report.

CIB: 2017 Updates to the Child and Adult Core Health Care Quality Measurement Sets

This week the Centers for Medicare & Medicaid Services (CMS) released an informational bulletin describing the 2017 updates to the core set of adult and children's health care quality measures for Medicaid and the Children's Health Insurance Program (CHIP).  The informational bulletin can be accessed on  here.  
Court Ruling May Increase Role of Mental Health Professionals in Evaluating Gun Rights

This past September, the U.S. Circuit Court of Appeals for the Sixth Circuit ruled that a federal law permanently barring the sale of firearms to people who have been involuntarily hospitalized for a mental illness was unconstitutional. The case centered around a 74-year-old Michigan man named Clifford Tyler, who, in 2011 was denied from purchasing a gun after a background check revealed that 25 years earlier, distraught over an impending divorce, he had been committed to a psychiatric hospital.  

In a  column  published recently in 
Psychiatric Services in Advance, Paul Applebaum, M.D., the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law at Columbia University, pointed out that this decision could impact mental health professionals and organizations that predominantly favor gun restrictions and a desire to reduce discrimination among people with mental illness. "There is likely ... to be a certain amount of ambivalence about endorsing an approach that will restore gun access to at least some people with histories of involuntary hospitalization, even if doing so enhances the extent to which they are treated as ordinary members of society-otherwise an important goal," he wrote.  Read more here .
Mental Disorders Top National List of Health Conditions

Mood and substance abuse disorders top the list of conditions negatively affecting the health of Americans with commercial health insurance, the newly published Blue Cross Blue Shield (BCBS) Health Index shows.
On the basis of data from more than 40 million BCBS members, this first-its-kind index identified depression, anxiety, and other mood disorders as the top category of health conditions affecting longevity and quality of life. Substance use disorders were number five.

According to Maureen Sullivan, chief strategy and innovation officer for the BCBS Association, the developers of the index started with data from millions of Blue Cross claims and used other information on healthcare costs and global burden of disease. They used an algorithm to measure how debilitating a condition is and how it affects quality of life.

They measured the prevalence, claims costs, and impact of more than 200 conditions.  Read more here.
Helping Ex-Inmates Stay Out Of The ER Brings Multiple Benefits

The Washington, D.C., jail has big metal doors that slam shut. It looks and feels like a jail. But down a hall in the medical wing, past an inmate muttering about suicide, there's a room that looks like a normal doctor's office.

"OK, deep breaths in and out for me," says Dr. Reggie Egins to his patient, Sean Horn, an inmate in his 40s. They talk about how his weight has changed in his six weeks in jail, how his medications are working out and if he's noticed anything different about his vision. Egins schedules an ophthalmology appointment for Horn.

Horn says before he arrived here, things were not looking good.

"I looked real bad. I was homeless, for one, and not taking my medicine," says Horn, who has depression, high blood pressure and gout, among other things.

When he was out on the streets, Horn says, it was hard for him to get his medications or to see a doctor. So he just didn't. He got sicker and sicker.

"I had two heart attacks and my gout flared up a whole lot of times when I was out there," he says.

Horn is no outlier. People with a history of incarceration are typically  much sickerthan the general population, especially returning inmates like Horn. Studies done primarily in Ohio and Texas  have found that more than 8 in 10 returning prisoners have a chronic medical condition, from addiction to asthma. Egins says a lot of it has gone untreated, for a range of reasons - because the health care system is tough to navigate, because they're homeless and don't have insurance, or because they don't trust doctors.  Read more here.



CTAC is offering a 6-part webinar series on the broad principles and core competencies of documentation for direct service providers and supervisors. 

December 14, 12 - 1 pm  

Without a stable place of residence, it is exceedingly difficult for disabled individuals to address their many healthcare needs. This webinar reviews research confirming the importance of housing for individuals with special needs, and explores what is currently being done to help them achieve housing stability and good health.

December 19, 10 - 11 am

Representatives from NYS OMH, OASAS, DOH, and OCFS will review the designation process and application for providers interested in offering children's State Plan Amendment (SPA) services and Home and Community Based Services (HCBS).




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

RPC Advisory Committee 
December 15:  8 am
GTM Only  

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

Office Closed - Christmas
December 26

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
Regional Planning Consortiums Update - Mid-Hudson Region

The Mid-Hudson region held its second RPC Stakeholder Meeting on November 28th. The event was well-attended and included various stakeholders from across the region. The meeting focused on a review of the RPCs and revealed the current slate of nominees for the Mid-Hudson RPC Board of Directors.  A huge thank you to the Mid-Hudson DCSs and Mid-Hudson RPC Coordinator, Marcie Colon, for organizing a successful meeting. If you are interested in learning more about the RPCs and attending your region's RPC stakeholder meeting please visit
New York Receives Five-Year Renewal of Major Medicaid Waiver

The Cuomo administration on December 7th announced it has received federal approval to extend its Medicaid waiver for five years, taking it beyond the first term of a Trump administration and providing much sought-after security to health policymakers who fear that Medicaid is about to be upended.

The 1115 waiver, called the MRT Demonstration, will run through March 31 2021.

The document, a two-way contract that can't be broken by one party, governs the vast majority of how New York's Medicaid program operates, including the $7.3 billion Delivery System Reform Incentive Payment program, the centerpiece of the Cuomo administration's effort to reform Medicaid.

Jason Helgerson, the state's Medicaid director, said last week that locking up a deal, which he had been negotiating with the federal government for the past two years, was one of his top priorities for the remainder of 2016.   Helgerson's concern was based on uncertainty over the future of the Medicaid program.

U.S. Rep. Tom Price, President-elect Donald Trump's choice to lead the Department of Health and Human Services, and House Speaker Paul Ryan favor Medicaid block grants, which would mean the states would receive a set amount of money to pay for the Medicaid program. Block grant programs typically don't have waivers.

Seema Verma, Trump's pick to run the Centers for Medicare and Medicaid Services, favors consumer-directed Medicaid programs, which give enrollees something akin to a health savings account.

The details of these programs remain to be seen but New York has for 20 years used this waiver to move providers away from a fee-for-service model, and based many of its efforts and programs on the assumption that the Medicaid program would stay, more or less, unchanged. 

Providers Concerned About Future Medicaid Block Grant Models

Healthcare providers are becoming increasingly concerned about suggestions by President-elect Donald Trump and GOP proposals that would transform Medicaid into a block grant model. Today, the program is operated as a federal and state partnership with the federal government funding about 57% of the costs.

Such a model would place absolute limits on federal outlays and make its spending more predictable. Some advocates fear the fundamental change in the program's structure would result in less funding in the future, causing a reduction in health services and/or cost shifting to states, counties and consumers. According to the  Commonwealth Fund, some 73 million people have Medicaid coverage currently-the majority are children-and 80% of the program is administered by contracted managed care organizations.
Brian Bowden, associate legislative director of health for the  National Association of Counties (NACo), says any potential Medicaid changes could be critical for behavioral health providers because the program funds the largest share of delivered services in mental health and addiction treatment.

He says Medicaid is currently designed to allow the federal government's matching funds to follow the need, while a block grant could limit that responsiveness.  Read more here.
Medicaid Coverage For Addiction Treatment Varies Dramatically

When Ashley Hurteau, 32, was arrested in 2015, she faced a list of charges for crimes she committed to finance a drug craving she had struggled with for more than a decade.

"I wasn't using it to get high," she said. "I was using it to survive."

Homeless, uninsured and addicted to heroin, Hurteau, a New Hampshire resident, had tried and failed to get help. Services came at a price she couldn't afford.

But in 2014, Hurteau's home state of New Hampshire expanded Medicaid. She qualified for coverage, giving her access to intensive outpatient treatment through the county's drug court program.

New Hampshire, along with 30 other states and the District of Columbia,  expanded eligibility for the state-federal low-income health insurance program under the Affordable Care Act. Hurteau is among the 1.6 million Americans who since then have had access to substance abuse services.

But a  study published Monday in the journal Health Affairs found significant disparities in coverage among the states.  

Researchers sought to determine the number of substance treatment services available in each state in 2014. They analyzed coverage for the four tiers of services recognized by the American Society for Addiction Medicine, which are classified as outpatient (including group and individual therapy as well as recovery support services), intensive outpatient, short- and long-term residential inpatient and intensive inpatient care for detoxification. Data was collected from the annual National Drug Abuse Treatment System Survey and state Medicaid directors.
Read more here .
Signed Out Of Prison But Not Signed Up For Health Insurance

Before he went to prison, Ernest killed his 2-year-old daughter in the grip of a psychotic delusion. When the Indiana Department of Correction released him in 2015, he was terrified something awful might happen again.

He had to see a doctor. He had only a month's worth of pills to control his delusions and mania. He was desperate for insurance coverage.

But the state failed to enroll him in Medicaid, although under the Affordable Care Act Indiana had expanded the health insurance program to include most ex-inmates. Left to navigate an unwieldy bureaucracy on his own, he came within days of running out of the pills that ground him in reality.

"I have a serious mental disorder, which is what caused me to commit my crime in the first place," said Ernest, who asked reporters to use only his middle name to protect his privacy. "Somebody should have been pretty concerned."

The health law was supposed to connect Ernest and almost all other ex-prisoners for the first time to Medicaid coverage for the poor, cutting expensive visits to the emergency room, improving their prospects of rejoining society and reducing the risk of spreading communicable diseases that flourish in prisons.

But Ernest's experience is repeated millions of times across the country, an examination by The Marshall Project and Kaiser Health News shows.   Read more  here . Campaign to Focus on Depression, Suicide, Alcohol abuse and Drug Abuse in Western NY

BUFFALO - The Mental Health Association of Erie County Inc. and the Erie County Council for the Prevention of Alcohol and Substance Abuse held a media event to officially launch, a public awareness campaign to promote mental, emotional and behavioral health throughout the eight counties of western New York.

The campaign is being contracted through Millennium Collaborative Care and Community Partners of WNY, two performing provider systems funded by New York State as part of the Delivery System Reform Incentive Payment program, and with support from community organizations in all eight Western New York counties.

According to Kenneth P. Houseknecht, MHA executive director, the campaign will focus on four key areas - depression, suicide, alcohol abuse, and drug abuse - with a special emphasis on prevention and early intervention among at-risk individuals in the 14-26 age range.   Read more here .
Why Value-Based Purchasing Is Harder For Community Behavioral Health - And What To Do About It

The other day, we took a look at how the shift to managed long-term services and supports, coupled with the move to value-based care, is posing a double challenge for many provider organizations (see  For Many Provider Organizations, The Shift To Managed Long-Term Care Is A Double Whammy).

As the former chief executive officer of a community mental health center (CMHC), it got me thinking about the many challenges facing provider organizations as part of this conversation. While CMHC executives have long believed that the fee-for-service payment system was not a sustainable model for serving the most ill individuals, I'm not sure that the leap to value-based contracts will be seen as a solution - at least not immediately.

First, there is the concern about the "performance" side of the value-based reimbursement. Many behavioral health providers, including community mental health centers, give priority to serving people with serious and disabling behavioral health disorders. Payers and provider organizations have had great difficulty defining "quality."
While standardized behavioral health quality measures are in development, they are not yet uniformly recognized in the professional community. And, payer performance metrics are often geared to client populations with less severe disorders and may penalize providers serving a disproportionately more disadvantaged population.  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.