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July 20, 2016

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

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Francine Sinkoff, Editor

DOH Health Home Serving Children (HHSC) would like to invite LGU and SPOA County Representatives and identified staff to attend a webinar that will specifically walk the LGU/SPOA through the process of:  
  • Obtaining a Health Commerce System account and identifying the appropriate person to assist other staff in obtaining access;
  • Access to Medicaid Analytics Performance Portal (MAPP) - HH Tracking System where the referral portal for Health Homes will be housed;
  • Identifying who will be the MAPP Gatekeeper and obtaining access;
  • Identifying who will be the Single Point of Contact (SPOC) for the county and DOH Health Home team.
The webinar will also have a Q & A portion to assist those at the county that have further questions.  The webinar will be on July 21st at 9:30 am

Click HERE to register.
HHS Raises Buprenorphine Cap to 275

Federal officials on July 5 announced that the cap on the number of patients an individual physician can treat with buprenorphine will increase to 275 beginning early next month. They also announced a separate proposed rule change designed to reduce the impact of patient pain surveys on prescriber decision-making.

Health and Human Services (HHS) Secretary Sylvia Burwell and Office of National Drug Control Policy (ONDCP) Director Michael Botticelli highlighted their call for Congress to fund President Obama's $1.1 billion budget request to fund strategies to combat the opioid crisis.

With congressional conferees this week negotiating final details of compromise opioid-focused legislation from bills passed in the two houses, Botticelli pointed out that without a significant infusion of resources well beyond what the congressional bills have called for, the legislation will not lead the nation toward an end to the addiction and overdose crisis.  Read more here.
Five Voices on Reforming the Front End of Justice

The Prisoner Reentry Institute of John Jay College, with support from the Laura and John Arnold Foundation, recently released  two reports  on national roundtables convened to explore pretrial practice, the "front door" to the criminal justice system. The college asked five of the participants - a police chief, a district attorney, a public defender, a probation officer and the head of the national umbrella group of county executives - to reflect on what they have learned about how to divert suspects from that front door without compromising public safety. These essays, provided to the Marshall Project, have been edited for length and clarity. The Arnold Foundation is a financial supporter of The Marshall Project.  

Where Police Are Told to Be "More Peace Corps Than Special Forces"


I have spent more than two decades in law enforcement in Camden, N.J., a city whose crime and poverty rates are among the highest in the nation. In 2012, we had 67 murders, a murder rate 17 times the national average. In such times of crisis, leaders often are more receptive to innovative solutions, and that's what happened in my city. In 2013, the city, county, and state created a new, consolidated police organization at the Camden County level, and I was chosen to lead that department.

We knew that we couldn't arrest and enforce our way out of crisis. Those tactics had been tried and had failed. We needed different strategies.  Read more here .
SCAA/UHF Report Shines Focus on Children's Needs

The Schuyler Center, together with United Hospital Fund, recently released an exciting new report, entitled,  Value-Based Payment Models for Medicaid Child Health Services
The report, believed to be the first published effort to develop a value-based payment approach for children in Medicaid, supports the path the Board based on research on effective clinical and social interventions for children, research on payment innovations across the country, and Medicaid utilization data. Although the utilization data is New York-specific, the information and models presented have national applicability.
Commissioned from Bailit Health, the report notes that, "Given the increased recognition of how profoundly social determinants of health (including Adverse Childhood Experiences) affect childhood development and adulthood health and social productivity, payment models need to consider how to motivate and support attention in this area."  The report presents a possible payment model for the large majority of children that includes risk-adjusted primary care capitation payments that reflect screening and interventions addressing psychosocial risks; care coordination payments; and performance incentives for outcomes like kindergarten readiness.
Frustrated You Can't Find A Therapist? They're Frustrated, Too

There are a lot of people suffering from a mental health condition who need therapy. And there are a lot of therapists who want to help them. But both sides believe the insurance companies that are supposed to bring them together are actually keeping them apart.

Insurance companies, for their part, say there's a shortage of therapists.
But it's not that simple. Especially in urban areas, there are lots of therapists. They just don't want to work with the insurance companies.

Take Michael Klein, a psychologist practicing in San Francisco for more than 20 years. He considers it his spiritual calling to help people calm their social anxiety and to help couples stop fighting and build trust.

"With the right kind of support, they blossom," he says.

Klein doesn't accept insurance. In fact, nearly half of therapists in California don't take insurance, according to a  recent survey from the California Association of Marriage and Family Therapists. The same is true of  psychiatrists. There are two reasons why, Klein says.  Read more here.



HCBS Rates and CFR Webinar for Adult BH HCBS Providers 
Please join MCTAC and state partners for a webinar for Adult BH HCBS Providers. The webinar will cover CFR reporting, reimbursement rates, and information regarding State Aid Grants. 

Thursday, Aug ust 4th: 3-4 pm. Register here!

July 21, 1 - 2 pm

July 28, 1 - 2 pm

Other MCTAC Webinars:

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


July 26, 3 - 3:20 pm, SAMHSA-HRSA

July 29, 2 - 3:30 pm,  National Reentry Resource Center


JULY 2016

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

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

RPC Advisory Call
July 28:  8 - 9 am
GTM Only


RPC Advisory Call
August 11:  8 - 9 am
GTM Only

RPC Advisory Call
August 25:  8 - 9 am
GTM Only

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
Senate Approves Bill to Combat Opioid Addiction Crisis

The Senate last Wednesday approved a bill to tackle the nation's opioid crisis, sending to the president's desk the most sweeping drug legislation in years in a rare instance of consensus in Congress.

The measure, which passed, 92 to 2, would strengthen prevention, treatment and recovery efforts, largely by empowering medical professionals and law enforcement officials with more tools to help drug addicts. It would also expand access to a drug that emergency medical workers could use to help reverse overdoses and improve treatment for the incarcerated. Senator Ben Sasse, Republican of Nebraska, and Senator Mike Lee, Republican of Utah, voted against the measure. President Obama is expected to sign the bill.

"This is a historic moment, the first time in decades that Congress has passed comprehensive addiction legislation, and the first time Congress has ever supported long-term addiction recovery," said Senator Rob Portman, Republican of Ohio, whose state has been plagued by opioid addiction. "This is also the first time that we've treated addiction like the disease that it is, which will help put an end to the stigma that has surrounded addiction for too long."    Read more  here .
Governor Cuomo Announces Aggressive New Statewide Enforcement Actions to Combat the Illegal Sale of K2 
Governor Andrew M. Cuomo last week announced a new series of aggressive enforcement actions to combat the illegal sale of K2 and other synthetic drugs. The Governor announced the State Department of Health's Bureau of Narcotic Enforcement, in partnership with the New York State Police, will step up enforcement efforts in communities across the state to crack down on the illegal sale of K2.

Additionally, the Governor will require that the State Liquor Authority and New York State Gaming Commission increase their oversight and enforcement efforts to revoke a store owner's liquor and lottery licenses if they are found to be illegally peddling K2.

"The evolution of synthetic drugs is an alarming public health risk - but we are on the front lines of the battle," Governor Cuomo said. "The state will continue to identify emerging compounds that put users in danger and aggressively chase down sellers of these toxic substances."

Beginning last week, the state stepped up enforcement efforts and increased state police presence to ensure that businesses fully comply with all applicable New York State laws, including the 2015  emergency regulations  banning the manufacture, sale, and distribution of synthetic drugs. New York will vigorously pursue all available civil, criminal, and administrative remedies against any business or business owner found to be manufacturing, possessing for sale or selling illegal synthetic drugs.  Read more here.
CMS Proposes Changes in Payment Rules for Outpatient Care

On July 6, 2016, the Centers for Medicare and Medicaid Services (CMS) proposed changes in Medicare payment methods under the hospital outpatient prospective payment system (hospital outpatient PPS) and the ambulatory surgical center (ASC) payment system.  The proposed Medicare rules would have a substantial impact in 2017 on "off campus" ambulatory facilities, incentive payments for adoption and "meaningful use" of electronic health records (EHRs), and the hospital value-based purchasing (VBP) program. 

The proposed rules would:
  • Require some "off campus" facilities not billing Medicare under the hospital outpatient PPS before November 2, 2015 to bill Medicare under the Medicare physician fee schedule or the ASC payment system, rather than the hospital outpatient PPS.  Ambulatory facilities located more than 250 yards from a main hospital campus could be considered "off campus" facilities.
  • Allow EHR "meaningful use" for a year to be shown over a 90 day period, rather than an entire year.      
  • Adopt new quality of care metrics under the VBP program, such as metrics on reducing the need for emergency department visits for patients undergoing chemotherapy.
  • Remove certain pain management survey questions from the VBP program based on concerns that they might become a factor in over-prescribing of opioids and other pain medications.
Overall, the proposed rules would increase Medicare hospital outpatient PPS payments by about 1.6 percent and would increase Medicare ASC payments by about 1.2 percent in 2017.  The proposed rules were published officially in the Federal Register on July 14, 2016.  Public comments will be due September 6, 2016. Additional information is available  here  and  here.

--Public Consulting Group
Cuomo Administration is Asking the Federal Government to Expand the Definition of "Safety Net" 

The Cuomo administration is asking the federal government to expand the definition of "safety net" provider so that an additional 7,000 primary care physicians may qualify for more money from the state's Medicaid waiver program. The Delivery System Reform Incentive Payment (DSRIP) program requires primary care providers to have at least 35 percent of their patients on Medicaid or uninsured to qualify as a safety net provider. 

Those who do not qualify can still participate in the $8 billion Medicaid reform program but can receive no more than 5 percent of a project's total valuation. Only about one-third of the state's doctors meet the current safety net definition, and in some Performing Provider Systems - the networks of providers charged with implementing the Medicaid reforms - 90 percent of physicians do not qualify for safety net status. State officials are concerned that without the safety net designation physicians won't feel the financial reward is worth the effort and many could choose not to participate, hurting the state's chances of meeting its performance goals and drawing down federal funds. 

The state health department has asked the federal government to expand the definition so that any physician with at least 25 Medicaid patients could qualify as a safety net provider. That would roughly double the number of physicians who qualify. The move, if accepted, would be particularly helpful to the Performing Provider Systems serving upstate such as the Adirondack Health Institute and Albany Medical Center. The proposal is open to public comment and can be seen here.
United Hospital Fund Analyzes Medicaid Spending on and Service Utilization by Children in New York

Two new complementary reports from United Hospital Fund's Medicaid Institute present data on Medicaid spending for and utilization by Medicaid beneficiaries under the age of 21 in New York, focusing specifically on the 1.77 million who were continuously enrolled in the program for all of 2014. (Medicaid covers 2.19 million of the 5.04 million children under age 21 in New York.) The reports are part of a growing UHF body of work that examines opportunities to improve children's health, especially in the context of payment reform, including value-based payment.

The two reports are Understanding Medicaid Utilization for Children in New York State: A Data Brief, a narrative that provides context and analysis, and Understanding Medicaid Utilization for Children in New York State: A Chartbook, which presents more extensive pie charts, bar graphs, and other figures in support of the analysis in the data brief.  To access these reports, click here.

NYS Amended HCBS Settings Transition Plan Now Available for Public Comment

The Office for People With Developmental Disabilities (OPWDD) is pleased to announce that the New York State Amended Home and Community Based Settings (HCBS) Transition Plan is now available for public comment and can be accessed through the New York State Department of Health's website here.

The Amended Statewide Transition Plan includes a significant amount of information regarding OPWDD's HCBS settings transition activities (pages 61-156).   The deadline for comments is August 19, 2016 by close of business.   Comments can be emailed to or mailed to:

New York State Department of Health
Office of Health Insurance Program
Division of Long Term Care
Attn: Deborah Rhatigan
One Commerce Plaza
99 Washington Ave., Suite 1620
Albany, NY 12210

It's All About Access:  Rural Healthcare Solutions Focus on Connecting Patients and Providers

The allure of endless skies, vast tracts of land, and delicious solitude has drawn people to the American West since the days when covered wagons constituted innovative technology. Self-reliance and access to the outdoors remain entrenched in the ethos of rural Western life. Love thy neighbor, sure, but also cherish the ability to escape him, to vanish into the hills or fields when the spirit catches you. Seclusion is a perk.

Too often, however, the epic distances and luxurious privacy that make the rural West so appealing impede the provision of healthcare. Patients who could see a doctor immediately in urban settings find themselves driving hours for simple services in rural ones. The need for emergency care necessitates life-saving helicopter flights that cost tens of thousands of dollars. Rural counties struggle to attract top-notch doctors, nurses, physician assistants, and other providers, and the grinding poverty that pervades many remote areas bankrupts hospitals and clinics - even as it contributes to more, and more serious, illness and injury.

Access to mental and behavioral healthcare is particularly lacking:   According to the National Rural Health Association, men - and increasingly women -  in rural areas suffer far higher suicide rates than their urban counterparts.  Read more  here .
AHRQ Says Telehealth Evidence Strongest for Chronic Conditions, Psychotherapy

The Agency for Healthcare Research and Quality (AHRQ) has come out with a review of the telehealth research that is more thorough than surprising.  

The agency's researchers concluded in a technical brief that the evidence for telehealth having benefits is strongest in three areas: remote monitoring of patients with chronic conditions, communication and counseling of people with chronic conditions, and psychotherapy as part of behavioral health.

This kind of research-a review of the reviews-can show that conventional wisdom is more conventional than wise. But in this case, it affirms rather than toppled expectations.

In those three areas, the AHRQ researchers suggested that research should pivot away from efficacy to scoping out ways that telehealth could be better implemented and barriers to its wider use removed.   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.