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July 7, 2017

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

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Francine Sinkoff, Editor

New Richmond Hill (Staten Island) home to support individuals with developmental disabilities

After heroin deaths, Broome officials building overdose database

NYS OASAS commissioner addresses heroin, opiate crisis in North Country

Sheriff CARE officially underway in Orleans County

Calling 911 During An Overdose Won't Lead To Arrest, NYPD Says

MRT - Long Term Care Workforce Investment Organization DRAFT Application

The Long Term Care Workforce Investment Organization Application is a DRAFT posted for public comment, as required by the 1115 waiver language. The draft application and further background about the Managed Long Term Care (MLTC) Workforce Investment Program can be found here.

An updated document will be available by August 4, 2017. Please send any comments to  
NYS is Expanding the OnTrackNY Program!

The NYS Office of Mental Health is expanding the OnTrackNY Program to reach more young New Yorkers in need of services.  OMH  recently announced that OnTrackNY is now offered in the Southern Tier by the Greater Binghamton Health Center. This is the 20 th OnTrackNY location in the State, and OMH will soon announce two new locations in Brooklyn.
OnTrackNY is a highly successful statewide program that helps young adults with newly emerging psychotic symptoms. Early intervention at the very onset of psychosis can help individuals avoid institutional care, remain integrated in their communities and achieve their personal recovery goals for school, work and social relationships.
The innovative, team-based approach provides psychiatric treatment, employment and educational services, peer services, as well as family education and support.  To learn more about OnTrackNY click here.
Joint Commission Making 
Measurement Based Care a Requirement for Addiction Treatment Accreditation

In January 2018, the Joint Commission will make measurement-based care (MBC) a new requirement for addiction treatment accreditation. Although the Joint Commission has mandated that addiction treatment programs systematically use symptom scales throughout patient care (measurement-based care), most centers do not have measurement-based care in place today. Evidence indicates that using these scales systematically helps patients get better faster.  Read more and find support materials here.
Commonwealth Fund:  High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care?

Health systems, payers, and providers are increasingly focused on finding better ways to deliver care for high-cost patients-those who account for a high proportion of health care spending-as a strategy to improve patient outcomes and reduce health care spending.  Yet targeting patients on the basis of cost alone, without considering their differing personal characteristics and needs, might not properly identify patients for whom an intervention would be most effective. Thus, we require a better understanding of the relationship between high needs and high spending.

This brief examines health care spending and use of services among adults with high needs, defined as people who have three or more chronic diseases and a functional limitation in their ability to care for themselves (such as bathing or dressing) or perform routine daily tasks (such as shopping or preparing food). Using nationally representative data from the 2009-2011 Medical Expenditure Panel Survey (MEPS), we found one of 20 adults (5%) in the U.S. population age 18 and older living in the community, or about 12 million people, met this definition of high need. 
Podcast:  Fixing the 5 Percent 

"Super-users" with complex medical needs make up a small fraction of U.S. patients, but they account for half of the nation's overall health-care spending. Now, innovative efforts are providing better care at lower costs.
MCTAC:  In-Person Recovery-Oriented HCBS Trainings

As a continuation of the Adult BH HCBS Roadmap Training Series, MCTAC, Technical Assistance Training Partners, and our State partners, OMH and OASAS, are happy to announce the next round of in-person events: "Recovery-Oriented HCBS: Challenges and Opportunities." 

These trainings are intended for care managers and adult BH HCBS providers working directly with service recipients to assist in providing HCBS services grounded in a recovery oriented approach. 
Participants will have an opportunity to:
  • Identify and implement two important recovery-oriented competencies: person-centered planning and motivational interviewing
  • Apply a recovery-oriented lens to specific HCBS services
  • Engage other provider agencies to enhance the coordination of HCBS and other clinical services. 
Click here for a calendar of these upcoming in-person events.

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

September 12, 2:30 - 3:30 pm, National Council for Behavioral Health


JULY 2017

Mental Health Committee Meeting
July 13:  11 am - 12:30 pm, GTM

Chemical Dependency Committee Meeting
July 14:  11 am - 12:30 pm, GTM

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

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

CSPOA / DOH / OMH Monthly Call
July 20:  3 - 4 pm, GTM


Officers, Chairs & Regional Reps Call
August 2:  8 - 9 am

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
Kendra's Law Extended for Five Years

On June 29, a day before the Assisted Outpatient Treatment (AOT) program was due to expire, the Governor signed legislation to extend Kendra's Law for five years, until June 30, 2022.
This was not the only AOT bill being considered by the Legislature this session. The Senate introduced S.5389 (Young), which was drafted by OMH to extend the AOT program for 5 years and make two additional amendments. These changes included:  (1) authorizing DCSs to require OMH providers to release information for the filing of AOT petitions; and, (2) allowing a new petition for AOT within six months of an expiration of an order if the individual significantly decompensated. The Conference was very supportive of this legislation and issued a   memo in support on behalf of the bill. However, the Assembly would not introduce this bill and would only agree to extending the AOT program for five years.
While the Conference does have some concerns about the future of AOT, the Conference supported a five-year extension of the law and the changes proposed in the OMH Departmental bill. One major concern from the county viewpoint is that while the numbers of AOT referrals continue to increase, especially from State prisons, the state aid to the counties which was promised at the time of passage, has decreased or disappeared causing a major cost to the counties. There is also concern of how the changes in funding of behavioral health due to the transition to Medicaid managed care and potential cuts from the federal government due to the possible repeal and replacement of the Affordable Care Act (ACA) might affect the program. Therefore, the Conference believes that a five-year extension of the program is appropriate.
During the upcoming budget process, the Conference will advocate for the state to provide a dedicated funding stream for the LGUs to administer the AOT program, as was promised at the time of passage.

-- Debra Holland, CLMHD Director of Governmental Relations
OPWDD Announces People First Care Coordination and CCO Draft Application

People First Care Coordination

"Putting People First" is OPWDD's guiding principle. It represents an ongoing commitment to ensuring that New Yorkers with intellectual and developmental disabilities get the high-quality, person-centered supports and services they want and need for a full and healthy life.   As people's expectations and needs evolve, so must the coordination and delivery of their services and supports. With this goal in mind we are pleased to introduce a new approach called People First Care Coordination.   People First Care Coordination will combine services for developmental disabilities with health, wellness, or behavioral health services to create a single, integrated and individualized Life Plan.

Care Coordination Organizations - The Heart of People First Care Coordination

Currently, services for people with developmental disabilities are coordinated by Medicaid Service Coordinators (MSC).  The new era of People First Care Coordination will have as its foundation the creation of Care Coordination Organizations (CCOs).  Also known as Health Homes, CCOs will coordinate a variety of healthcare, wellness and Developmental Disabilities (DD) services to achieve a holistic and integrated approach to meeting the full range of needs.  A specialized team, comprised of a care manager working together with other professionals will work with the people we serve and their families to plan, execute and monitor individualized Life Plans. 

The first step in the transition to People First Care Coordination is an application process.  Read the Message to Providers from Acting Commissioner Delaney announcing People First Care.   Groups of providers interested in becoming Care Coordination Organizations are invited to  view the application here .
Anti-Overdose Drug Naloxone to be Available at All New York State Courts, Officials Say

The opioid antidote Naloxone will be made available at all New York State courts as part of a new initiative to combat the drug epidemic, officials said Thursday.
State court officers and sheriff's deputies will receive training on how to use the lifesaving drug starting in mid-July.

The program will be implemented statewide by the end of the year, said Chief Administrative Judge Lawrence Marks.
"When a medical-related emergency arises in the courthouse, every second matters," said Chief Michael Magliano, the state court system's top cop.

"With opioid addiction at crisis levels in communities around the State, this initiative will undoubtedly serve to enhance public safety throughout the New York State Courts."  Read more here.
As Opioid Use Disorder Diagnoses Skyrocket Nearly 500%, Treatment Falls Behind

A study from the Blue Cross and Blue Shield Association adds to the growing mound of evidence that the number of patients diagnosed with opioid use disorder far exceeds how many are getting treatment.  Blue Cross and Blue Shield analyzed medical and pharmacy claims data for more than 30 million of its plans' commercially insured members. It found that the number of members diagnosed with having opioid use disorder skyrocketed 493% from 2010 to 2016. 

In 2010, about 1.4 out of every 1,000 plan members was diagnosed with opioid use disorder, according to the report. That rate jumped to 8.3 members out of every 1,000 in 2016.  

But the number of members accessing medication-assisted treatment, or MAT, for opioid use disorder hasn't kept up. Just 3.4 out of every 1,000 members received MAT in 2016, up 65% from 2.1 in 2010.  Read more here
Without Medical Support, DIY Detox Often Fails

By the time Elvis Rosado was 25, he was addicted to opioids and serving time in jail for selling drugs to support his habit.

"I was like, 'I have to kick this, I have to break this,' " he says.

For Rosado, who lives in Philadelphia, drugs had become a way to disassociate from "the reality that was life." He'd wake up physically needing the drugs to function.
His decision to finally stop using propelled him into another challenging chapter of his addiction and one of the most intense physical and mental experiences he could have imagined: detoxing.

"The symptoms are horrific," Rosado says.

There are recovery and treatment centers that can help people quit using drugs - in fact, it's a  multi-billion-dollar industry. But this help can be expensive, and waiting lists for state and city-funded programs are often extremely long.

So can detoxing on your own be the solution?  In most cases, the answer is no. Read more here.
Urban Institute Report: Rapid Growth In Medicaid Spending On Medications To Treat Opioid Use Disorder And Overdose  

Between 2011 and 2016, spending on Medicaid-covered prescriptions used to treat opioid addiction and overdoses increased from $394 million to $930 million, an average annual increase of 19 percent. Spending grew faster in later years, with a 30 percent increase between 2015 and 2016. Certain states-including Kentucky, Maine, and Ohio-have seen particularly fast growth. These same states, and others, could be particularly hard hit by reductions in Medicaid spending growth under consideration in Congress because of their fast growth and high rates of fatal overdoses.  Click here for the report.
Better Communication Tools Needed to Support Payer-Provider Collaboration, Survey Finds

Online and multi-payer portals are viewed as promising solutions to improve communications between payers and providers while also mitigating costs, yet these tools are underutilized. While 60 percent of payers prefer the use of online portals as the primary means of communication with providers, it seems providers are less enthusiastic, as only 39 percent of practice-based providers and 40 percent of facility-based providers strongly support online portals as a primary source, according to a recent survey.

The survey conducted by Availity, a healthcare information technology company, found that while payers and providers want to collaborate more closely on value-based care initiatives, such partnerships remain vulnerable to poor data transparency, competing business goals, and significant administrative burdens.

The  survey , which included responses from 40 health plans and more than 400 practice- and facility-based providers, indicates that a majority of all groups believes that improved collaboration will lead to greater profitability. However, many of the same data-sharing and administrative issues endemic to fee-based healthcare are present in value-based initiatives.  Read more here.
Open Minds:  More Fuel For 'Integrated' Care

There is a lot of emerging data on how behavioral disorders, particularly untreated behavioral disorders, complicate the treatment of medical conditions - frequently resulting in poorer outcomes and increased costs.  This is the case made for "integrated" care.

But there is another issue that makes an equally compelling case for integrated care - the presence of anxiety disorder or depression that mask an underlying physical health problem. I hadn't thought much of this issue until I read,  When Anxiety or Depression Masks a Medical Problem, in a recent issue of The New York Times. The article refers to the concept of "medical mimics" - medical diseases that can present as mental health issues. A recent article in Psychiatric Times,  7 Medical Illnesses That May Present as Anxiety, lists seven medical issues (and 47 medical illnesses) that can present as anxiety, including cardiac issues, endocrine conditions, gastrointestinal conditions, inflammatory conditions, metabolic conditions, neurologic conditions, and respiratory conditions. The articles point out that neurological disorders, like multiple sclerosis or Parkinson's disease, often first present as behavioral disorders.  Read more here.
Report:  How Health Care And Community-Based Human Services Organizations Are Partnering For Better Health Outcomes

Healthcare organizations and community-based organizations (CBOs) that provide human services are partnering in shared pursuit of better health outcomes. The Partnership for Healthy Outcomes - Nonprofit Finance Fund (NFF), the Center for Health Care Strategies (CHCS), and the Alliance for Strong Families and Communities (Alliance), with support from the Robert Wood Johnson Foundation (RWJF) - set out to capture and analyze the lessons emerging in this dynamic space. Information from more than 200 partnerships serving all 50 US states provide important lessons from, and for, partnerships that hope to improve access to care, address health inequities, and make progress on social issues like food, education, and housing.  Click here for the report.
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.