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January 19, 2017

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

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Francine Sinkoff, Editor

Reducing the Number of People with Mental Illnesses in Jail: Six Questions County Leaders Need to Ask

Released by Stepping Up: A National Initiative to Reduce the Number of People with Mental Illnesses in Jail, this  report  is intended to assist counties with developing and implementing a systems-level, data-driven plan that can lead to measurable reductions in the number of people with mental illnesses in local jails. The report serves as a blueprint for counties to assess their existing efforts to reduce the number of people with mental illnesses in jail by considering specific questions and progress-tracking measures.
Report Highlights Ways All States Can Help People Leaving Prison and Jail Get Mental Health Care and Substance Use Treatment 

The CSG Justice Center's National Reentry Resource Center released a discussion paper that identifies key questions and issues every policymaker should consider when seeking to help people leaving prison and jail connect to needed mental health and substance use treatment. All states, regardless of the scope of their Medicaid coverage, can use this paper to ensure prisons and jails are positioned as effective hubs for helping eligible people get public health care coverage and social security and veterans benefits. This assistance can help facilitate easier access to treatment and help reduce recidivism as part of a comprehensive reentry effort.

Critical Connections: Getting People Leaving Prison and Jail the Mental Health Care and Substance Use Treatment They Need-What Policymakers Need to Know about Health Care Coverage highlights examples of local practices and legislative and administrative actions drawn from 30 states. With support from the U.S. Justice Department's Bureau of Justice Assistance, the paper illustrates how policymakers have used a wide range of strategies to improve connections to health care coverage and treatment.  Read more here.
New Guide for Providing a Trauma-Informed Approach in Human Services

The Administration for Children and Families, the Substance Abuse and Mental Health Services Administration, the Administration for Community Living and the Offices of the Assistant Secretary for Health and the Assistant Secretary for Planning and Evaluation at HHS have developed a " Guide to Trauma-Informed Human Services ."  The Guide is intended to provide an introduction to the topic of trauma, a discussion of why understanding and addressing trauma is important for human services programs, and a "road map" to find relevant resources.

There is increasing recognition in human services programs about the importance of being "trauma-informed," but there are often important questions about what it means to be trauma-informed, what such an approach implies for service delivery and staff training, and how the answers are similar and different across the array of human services programs.  The Guide seeks to address these and related questions, and we hope it will be both immediately helpful and a "living" document to be updated over time as knowledge and experience grow. Read more here.
Final Pass-Through Pay Rule Would Cost Hospitals More Than $3 Billion a Year

Bucking outcry from providers, the CMS has finalized a rule related to pass-through payments in Medicaid managed care. The rule would block billions in supplemental funding to safety net providers.

The rule applies to all states with Medicaid managed care plans and are used to entice providers to see Medicaid beneficiaries. The CMS doesn't have exact numbers of providers that would be affected but it's estimated to be thousands of hospitals, doctors and clinics.

The payments are paid to Medicaid managed care plans on top of the base capitation rate. The plans are required to pass these payments to contracted providers that treat a disproportionate share of Medicaid or uninsured patients with complex or costly cases. 

The CMS estimates that at least 16 states have paid out $3.3 billion in pass-through payments on average every year. Another three have distributed about $50 million a year for nursing facilities.  Read more here.
Do Pay-for-Performance Programs Improve Patient Outcomes? 

Value-based reimbursement models that pay for performance modestly incentivized providers to stick to clinical guidelines, but they may not be linked to better patient outcomes, a recent  Annals of Internal Medicine  study  indicates.

The literature review of 69 studies from June 2007 to October 2016 revealed no significant connection between consistently better patient outcomes and pay-for-performance programs, especially in the US. The evidence pointed to the value-based reimbursement model's ineffectiveness with improving patient outcomes, but researchers also suggested that other quality improvement interventions and a lack of "best" incentive structures may be the reasons for no clear evidence.

Out of the research in the review, researchers pointed out that pay-for-performance interventions across the world were not linked to  better patient outcomes, including healthcare and utilization outcomes.  Read more here.

January 19, 12 - 1 pm

January 25, 12 - 1 pm

February 8, 12 - 1 pm




Executive Committee Call (State Budget)
January 24:  9 - 10 am,  GTM

RPC Leads & Coordinators Call
January 26:  8 - 9 am,  GTM


Officers, Chairs & Regional Reps Call
February 1:  8 - 9 am,  GTM

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

OMH Agency Meeting
February 13:  10 am - 12 pm
44 Holland Ave., 8th Fl., Albany

OASAS Agency Meeting
February 13:  1 - 3 pm
1450 Western Ave., 4th Fl., Albany

Children & Families Committee
February 21:  11:30 am - 1 pm, GTM

RPC Leads & Coordinators Call
February 23:  8 - 9 am,  GTM

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
North Country RPC Board Holds First Meeting

The recently elected Board of Directors for the North Country Regional Planning Consortium (RPC) held its inaugural meeting in Lake Placid today. Click here to view the complete list of North Country RPC board members.  For more information about the RPCs, visit  
CLMHD Overview of 2017-2018 Executive Budget

Governor Cuomo released the 2017-2018 Executive Budget proposal late Tuesday evening.  CLMHD staff reviewed the proposal and compiled highlights  related  to mental hygiene.  Click here to read CLMHD's overview of the Executive Budget.

New Rule Improves the Exchange of Medical Information in Ways That Protect the Privacy of People Receiving Substance Use Treatment

The U.S. Department of Health and Human Services (HHS) finalized changes to Confidentiality of Alcohol and Drug Abuse Patient Records regulations, (42 CFR Part 2) to facilitate health integration and information exchange within new health care models while continuing to protect the privacy and confidentiality of patients seeking treatment for substance use disorders. The new rule is published in last week's  Federal Register here.

The current rules governing the confidentiality of substance use disorder records, often referred to as "Part 2," were promulgated in 1975 because of the concern that if the identities of people in treatment for substance use were revealed those patients might be subject to criminal prosecution and a wide range of other serious social consequences. These harmful consequences could deter people from seeking needed treatment.
In February 2016, HHS issued a notice of proposed rulemaking (NPRM) proposing changes to Part 2 to reflect the current health care delivery system, promote health integration and permit appropriate research and data exchange activities. This final rule carefully balances the public health benefits of information exchange and continued protection of patient privacy.  Read more here.
Governor Cuomo Announces More Than $8.1 Million to Expand Substance Use Disorder Treatment Across New York State

Governor Andrew M. Cuomo last week announced more than $8.1 million awarded to eight addiction treatment providers in seven counties across New York State. Funding will support construction needs and operational assistance for treatment programming, and the development of up to 80 new residential treatment beds and 600 new Opioid Treatment Program slots. These awards build on the Governor's aggressive efforts to combat opioid misuse and heroin use, and the disease of addiction. 

Click here to view the following programs which will receive funding to support the development of new residential treatment beds and OTP slots. 
Mayor de Blasio Announces New Program Connecting Those Who Have Experience with Substance Use Recovery Programs with Training for Careers as Peer Advocates for Others in Recovery

Governor Andrew M. Cuomo last week announced more than $8.1 million awarded to eight addiction treatment providers in seven counties across New York State. Funding will support construction needs and operational assistance for treatment programming, and the development of up to 80 new residential treatment beds and 600 new Opioid Treatment Program slots. These awards build on the Governor's aggressive efforts to combat opioid misuse and heroin use, and the disease of addiction. 

Click here to view the following programs which will receive funding to support the development of new residential treatment beds and OTP slots. 
The Olmstead Housing Subsidy (OHS) Program

On August 1, 2016, the New York State Department of Health (NYSDOH) Medicaid Redesign Team (MRT) executed the Olmstead Housing Subsidy (OHS) contract. OHS funds rental subsidies and support services. This statewide program is administered by the New York Association on Independent Living (NYAIL).
The goal of OHS is to provide community transitional services, rental subsidies and capital improvements to help participants live safely and independently in the community.
To be eligible, an individual must:
  • Be enrolled in Medicaid
  • Be age 55 or older OR be age 18 or older with a documented chronic disability
  • Meet nursing home level of care as determined by the Uniform Assessment System for New York (UAS-NY)
  • Be living in a nursing home, or be homeless or unstably housed
  • Have spent at least one hundred and twenty (120) consecutive days in a nursing home over the most recent two-year period
  • Have the ability to live safely in the community
For more details about the program and more details about eligibility criteria, please contact NYAIL at 518-465-4650 or visit .  
DHCS Academy: First-in-the-Nation Experiment is a Big Success Story

Inside Sacramento's historic library building, 30 managers from California's Department of Health Care Services are working in small groups to resolve a thorny issue: how to structure value-based payments to providers that result in better health outcomes for people with complex needs.

This is DHCS Academy, the first program of its kind in the nation, where leaders of the state's Medi-Cal program gather every month to engage in case studies, work on leadership projects, and wrestle with innovations in financing, delivery system reform, and health care integration.

The department had two goals for the academy when it launched in September 2013: (1) to assure state staff have the knowledge and capacity to meet the increasingly complex and challenging task of effectively administering the Medi-Cal program, and (2) to build a deep bench of talent to ensure the department can effectively fill senior leadership positions from within. These goals are especially timely in light of the health policy changes expected from the incoming administration in Washington.  Read more here.
Jason Helgerson and Juliette Price:  "Cross-Sector Collaboration is a Game Changer for Social Change"

Most of today's most pressing social challenges are too complex for any single institution to solve. To move the needle, sectors will need to collaborate like never before. In this post, we get a glimpse into how such an approach is making an impact on some of New York State's most vulnerable children.  

To address the challenge of improving quality and addressing cost pressures within the NHS, the need for integration of social care and healthcare is clear. To do so will require cross-sector collaboration which seeks to collectively solve some of the most pressing social issues of our time. 

In a previous post, Jason Helgerson outlined the obligation healthcare providers have to become  agents for social change. Once healthcare leaders accept this challenge, the next question can be daunting - how?  

The truth is that today's most pressing challenges are far too complex for any single institution to solve. Consider a homeless man, relying on a local shelter for housing, while also using services from an NHS mental health trust. Or a frequent A&E user, who visits the local hospital because of substance abuse rather than for an acute healthcare need and who should be relying on a social service agency program for recovery services. Or even a single parent, whose mental health care directly impacts their child's attendance patterns at school.

All of these individuals use services from different sectors, and yet the lack of systems-level coordination usually results in a lack of progress towards solving the core challenge. But when organisations work together under the right conditions, they can accomplish amazing feats -ending homelessness in large cities, reducing the number of super-users using A&E at high rates, or even moving the dial on student achievement - all at population level. Read more here.
Affiliations Strengthen Not-for-Profits

To get a feel for the changing landscape in the behavioral health market, consider the fact that there have been at least 100 merger and acquisition deals among providers annually for the past three years in a row-a record amount of activity, according to data from the Braff Group. The deals are evidence of an undeniable consolidation trend.

Unfortunately, the trend might leave small, not-for-profit operators wondering how they can possibly compete with the growing field of large providers. After all, larger organizations are more likely to attract new patients, earn better payment rates from insurers and leverage economies of scale. It might seem impossible to survive without such strategic advantages.

"There are so many corporate mergers of for-profit behavioral health organizations happening, and they have developed the services for a continuum of care within their organizations," says Mary Woods, CEO of WestBridge, which offers dual diagnosis treatment in Florida and New Hampshire. "They might have 500 beds and have different levels of care."   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.