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April 21, 2017

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

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Francine Sinkoff, Editor

CMS Approval of Annual Update to VBP Roadmap

CMS recently approved the annual update to the Value Based Payment (VBP) Roadmap .  The final Roadmap along with CMS's approval letter is now available on the DSRIP VBP Webpage here .   The Roadmap was developed with the critical input of the Value Based Payment Work Group and other stakeholders, as well as the public through a public comment period.  
CMS's approval of the Roadmap reaffirms that New York State's Medicaid program is leading the way for the nation to shift towards value based payment and healthcare reform. 
VBP Quality Measures for Measurement Year 2017 Posted to DSRIP - VBP Resource Library

The Department of Health has updated the DSRIP - VBP Resource Library to include the VBP Quality Measure Sets for Measurement Year 2017 for the following VBP Arrangements:
  • Total Care for the General Population/Integrated Primary Care (TCGP/IPC) Quality Measure Set
  • Health and Recovery Plans (HARP) Quality Measure Set
  • HIV/AIDS Quality Measure Set
  • Maternity Care Quality Measure Set
These Measure Sets can now be found in the new tab titled " VBP Quality Measures " on the DSRIP - VBP Resource Library webpage here.

The measure sets provide a high-level overview of the process for measure set development as well as the listing of measures for the 2017 Measurement Year. The measure sets include all Category 1 and Category 2 measures for use in contracting between Managed Care Organizations and VBP Contractors. 

Any questions on the report can be sent to

Recovery Unscripted:  Decoding Success Rate Myths

Siobhan Morse, Division Director of Clinical Services for Foundations Recovery Network (FRN), knows the importance of data when it comes to addiction treatment. What's more important to her is the research and utilization of the right data and not just numbers for the sake of analytics.
  • Learn about Substance Abuse and Mental Health Services Administration (SAMHSA) patient evaluation standards
  • Discover how to use data to further a patient's recovery beyond the treatment center
  • Decide how to market your organization without deceiving potential patients
  • Focus on both the patients and their loved ones as well as clinical data
Click  here to listen to the Podcast.
The Bumpy Path To Value-Based Reimbursement Will Create New Winners

Medicare accountable care organizations (ACOs) have been in place since the passage of the Patient Protection & Affordable Care Act (PPACA) in 2010 - and have served as one of the primary models for moving provider organization reimbursement from volume to value. Since then, ACOs have expanded and evolved. There are over 800 public and private ACOs, operating across all 50 states, the District of Columbia, and Puerto Rico - approximately 460 Medicare ACOs, 316 commercial ACOs, and 62 Medicaid ACOs. These ACOs cover approximately 30 million people and 17% of the population.

But are they really moving the system from volume to value? At this point, the amount of "risk" in ACOs contracts has been limited. Of the Medicare ACOs, over 400 have no downside risk - only upside risk in shared savings. If you expand that to include all ACOs across all markets (Medicare, Medicaid, and commercial), 61% of ACO contracts have only upside risk with shared savings but no potential of financial losses (see  61% Of ACO Contracts Only Include Upside Financial Risk).  

This lack of risk sharing is not coming from the payers and health plans. The new Medicare "Next Generation" ACO models, for example, have both full risk and 80% risk models. But ACO managers themselves say they are not ready for the upcoming requirement that they accept two-sided risk models (se Most ACOs Not Ready For Two-Sided Risk Model ).  Read more here.
CCBHCs: Are You Ready to Grow Your Peer Services?

It takes more than sunshine and water for a robust Certified Community Behavioral Health Clinic (CCBHC) peer services program to sprout.

CCBHCs are a new provider type in Medicaid tasked with utilizing innovative and creative strategies to increase Americans' access to behavioral health care services. Beginning in 2017, CCBHCs will be established in eight states participating in the  Excellence in Mental Health Act demonstration: Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon, and Pennsylvania.

Peer services are one of the nine required services that CCBHCs must offer their clients. Since 2007, SAMHSA and the Centers for Medicare and Medicaid Services (CMS) have promoted the use of Medicaid for peer services. Including this unique service option in CCBHC requirements will expand on the momentum to offer peer services through Medicaid.

Per CCBHC definitions, peer support services are "designed and delivered by individuals who have experienced a mental or substance use disorder and are in recovery." A peer provider combines their lived experience with formal training to support their clients.   Read more here .
Five Ways Treatment Center Executives Can Prepare for the Future
[Behavioral Healthcare Executive] asked a number of technology leaders for suggestions on what treatment center executives should prepare for in the future. Here are a few of their tips.
  1. Patients with behavioral health disorders must be approached the same way as patients with other life-threatening conditions, says Chris Williams, marketing director for the Echo Group. "Rally around them and lift them up the way we would a cancer survivor," he says. And clinical outcomes data can be the key to telling success stories in the industry.
  2. According to Cory Valentine, vice president of sales and marketing for Sigmund Software, providers need to pay attention to patient engagement, especially when it comes to wellness. "Patients want to hear from their providers in sickness and in health," he says. Engagement will reduce recidivism as well. "It's going to become the cornerstone of healthcare," Valentine says.
Read more here.
Making Consumer Engagement A Reality

By definition, engaged consumers are consumers that take action to become better informed and more proactively involved in decisions and behaviors that affect their health, insurance coverage, and health care. Deloitte's 2015 report,  Health Care Consumer Engagement: No "One-Size-Fits-All" Approach, identified engaged consumers as those who are:
  1. Taking deliberate steps to monitor and improve their health
  2. Looking for information to learn more about health concerns and compare treatment options
  3. Taking cost and quality into consideration when choosing treatments, providers, and plans
  4. Partnering with health care professionals to make treatment decisions as well as communicating and sharing information with their care team
  5. Adhering to recommended treatment plans
Read more here.


April 24, 1 - 2:30 pm, SAMHSA

April 24, 3 - 4 pm, SAMHSA

April 25, 12 - 1 pm, National Council 

April 26, 2 - 3:30 pm, SAMHSA

April 26, 1 - 2 pm, Remarkable Health

April 27, 1 - 2 pm, National Council 

May 3, 1 - 2 pm, Behavioral Healthcare Executive

May 11, 2 - 3:15 pm, Stepping Up Initiative

May 16, 12 - 1 pm, PsychU

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

CLMHD Spring Full Membership Meeting
April 24 - 25, Holiday Inn, Saratoga

MAY 2017

Officers, Chairs & Regional Reps Call
May 3:  8 - 9 am, GTM

Mental Health Committee Meeting
May 9:  10 - 11:30 am, GTM

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

Children & Families Committee Meeting
May 16:  11:30 am - 1 pm, GTM

Directors & Executive Committee Meeting
May 17:  9:30 am - 12:30 pm, GTM

OMH Agency Meeting
May 23:  10 am - 12 pm
44 Holland Ave., 8th Fl., Albany

OASAS Agency Meeting
May 23:  1 - 3 pm
1450 Western Ave., 4th Fl., Albany

CLMHD Office Closed
May 29:  Memorial Day

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
Governor Cuomo Announces $6.5 Million to Expand Mental Health Services for Children Across New York

Governor Andrew M. Cuomo this week announced $6.5 million awarded to pediatric and family medical practices across New York. Funding will allow 17 health centers to implement the HealthySteps program, which works to integrate a child and family development professional into pediatric and family medicine offices to help identify, monitor, and address emerging behavioral or developmental health concerns in young children.

More than $6.5 million awarded to 17 medical practices throughout New York, includes funding to help support the implementation, evaluation and sustainability of the program. The awarded health practices range from federally qualified health centers and hospital-based clinics, to community health centers and private practices that serve high-need communities in both rural and urban areas. At full implementation, it is estimated that each of these practices will deliver HealthySteps services to 350 children and their families, engaging approximately 5,950 families over three years.  Read more here.
NYS OASAS Announces Opening of New Recovery and Outreach Center in Buffalo

The New York State Office is Alcoholism and Substance Abuse Services (OASAS)
this week announced the grand opening of BestSelf Recovery Community and Outreach  Center in Buffalo. The center will provide free support programs and services for Western New York residents in recovery from addiction.   The Center is supported through a $1.75 million award from OASAS.

Recovery Centers promote long-term recovery, by providing professional staff, peers and volunteers to engage and support people in recovery on their path towards wellness. The BestSelf Recovery Community  and Outreach Center will offer peer support, skill building, recreation, wellness education, employment readiness, and social activities in a safe, welcoming, and alcohol/drug free environment. Read more here .
NYS OASAS Announces Expanded Opioid Addiction Treatment Capacity in Onondaga County

The New York State Office of Alcoholism and Substance Abuse Services last week announced the opening of a new Opioid Treatment Program (OTP) in Syracuse, with the capacity to provide medication-assisted treatment for up to 250 people with an opioid addiction. The new program, opening today at 329 North Salina Street, will be run by Syracuse Behavioral Health (SBH) and co-located with their Integrated Outpatient Clinic, which provides a variety of additional services.

"Medication-assisted treatment is vital for so many people who suffer from substance use disorder," said New York State Office of Alcoholism and Substance Abuse Services (OASAS) Commissioner Arlene González-Sánchez. "The additional treatment slots and services Syracuse Behavioral Health will offer at this center are an important step in responding to the opioid crisis in Onondaga County and the whole Central New York region."

Syracuse Behavioral Healthcare was one of eight addiction treatment providers in seven counties across New York State selected to receive funding as part of the Governor's aggressive efforts to combat opioid misuse and heroin use, and the disease of addiction.
Read more here .
New State-of-the-Art Adolescent Treatment Center Opens in Erie County

It was a project three years in the making, but the ribbon has been cut to open at a new state-of-the-art residential facility for young people dealing with behavioral health issues. Those attending the Tuesday ceremony to dedicate the new Baker Victory Services building in Lackawanna say it creates an atmosphere of hope which, in turn, increases the chances for positive outcomes.

The center may house up to 40 young people, between the ages of 12 and 21, who need more intensive help with behavioral health issues. The amenities, Baker Victory Services chief executive officer Therese Scofidio explained, create a comfortable atmosphere.

And it creates a sense of hope that, New York State Office of Mental Health deputy commissioner Donna Bradbury suggested, increases the chances for successful treatment and reunions with the residents' families.  Read more here.
Medicaid Spending on Opioid Detox in NYS Dips

New York state spending on treatment for opioid addiction for Medicaid enrollees has increased dramatically in most categories since 2012, with one exception: crisis and detox services.

Data provided to Crain's by the state Department of Health show that spending on those services, meant to manage and treat withdrawal from opioids during short-term stays, dropped 22% over a four-year period, to $35.3 million, in 2016.

Crisis and detox services also received a relatively low level of investment from the state in the fiscal 2017 budget when compared with other types of treatment, indicating a move away from that approach.

"Recent increases in the availability of medication-assisted treatment and ambulatory services across New York state have resulted in a decrease in admissions to detox and crisis inpatient programs," the state Office of Alcoholism and Substance Abuse Treatment said in a statement when asked to explain the phenomenon.

Meanwhile, state Medicaid spending on other types of drug treatment has soared.The bill for longer-term inpatient and residential programs ballooned by about 47% between 2012 and 2016. Spending on care in outpatient clinics went from $45.8 million in 2012 to about $78 million in 2015-a 71% increase-before showing signs of slowing in 2016.

Medication-assisted treatment costs also increased substantially-by about 70% between 2012 and 2016, although the actual costs are difficult to determine. According to the Health Department, the state's bill for addiction-curbing medications like buprenorphine came to more than $284 million in 2016, but that's before rebates, which shave off 45% of Medicaid drug costs, on average. 

MRT Releases March 2017 Report

The NYS Medicaid Redesign Team (MRT) recently published a report which is intended to share the many accomplishments of the MRT by providing summaries of recently completed projects. 

Click here to view the report. 
Medicaid Responds To The National Opioid Epidemic: Regulating Prescribing And Finding Ways To Expand Treatment Access 

Medicaid programs are at the center of the opioid epidemic. Nearly 12 percent of adults  covered by Medicaid have a substance use disorder, including opioid use disorder. Available data suggest that Medicaid beneficiaries are  prescribed
painkillers  at higher rates than  non-Medicaid patients  and have a  higher   risk   of   overdose , from both prescription opioids and illegal versions including heroin and fentanyl. In addition to the human toll, abuse of opioids has significant financial effects. In 2010,
Arizona Medicaid  paid for more than half of all opioid-related emergency department admissions, and in 2012, 81 percent of the $1.5 billion in nationwide hospital costs related to neonatal abstinence syndrome  fell to Medicaid.

To better understand underlying Medicaid prescription opioid utilization, expenditures, and enrollee characteristics, and help inform policies to respond to the crisis, Medicaid and CHIP Payment and Access 
Commission  (MACPAC) looked at  Medicaid claims data  from calendar year 2010-2012, the most recent year for which such data are available at the national level. Read more here .
Suicide and the Rural ER

With psychiatrists as rare as Sasquatch, emergency rooms become rural America's portal to mental health care-or not.

I saw Jake in the emergency department of Tiny Memorial Hospital-both names have been changed for privacy-at 3 a.m. a few months ago. He was a spitting, screaming, muscular mess of rage. A local deputy brought him in handcuffs after his family called 911. He had been at his mother's home, banging his head on the wall and talking about suicide. He was drunk and cycling between rage and sobs. His young wife had left and taken their 2-year-old boy with her. Everything in Jake's life was spiraling out of control. The cause of the split was not forthcoming from anyone.

The deputy knew Jake from high school. He knew that he was serious; a determined, stubborn young man. There were no charges against him. His mother, through tears, simply said, "Please get him some help!" So the officer brought him to us and offered to stay as long as needed to keep him under control.

Jake had never been depressed or suicidal before. According to his shaken mother, her son was a hard worker who made good money in construction. He could build anything and was sought after by contractors. But lately, since his family troubles, he had been missing work and losing interest in his job, fun and even in food.

The night he came to the ER, he told his mother and sisters that if he could, he would just go into the woods with his rifle and shoot himself. Read more here.
Getting the Mentally Ill Out of Jails 

A dearth of beds at state psychiatric hospitals in many parts of the country and shortages of mental health resources mean that mentally ill people who commit minor crimes often end up languishing in jails, which are poorly equipped to handle their illnesses.

It's a difficult problem that, without intervention, creates a grim cyclical pattern: Untreated mentally ill people get carted off to jail, where their illnesses go unaddressed, which increases the odds that they will commit crimes after their release.

But cities, counties and states across the U.S. are attempting to break that pattern, using law enforcement and criminal justice tools to direct those with mental illness toward treatment services that could help them control behaviors that got them into trouble.  

The interventions come in many forms.
There are now more than 300 mental health courts, in which defendants deemed mentally ill are directed to mental health treatment services rather than incarceration. 
Read more here.
How Telehealth Platforms Will Reshape U.S. Healthcare Delivery

Telehealth in the United States is entering a new phase of accelerating growth. Indicators of this next phase include: FDA approval of remote diagnostic tools; the rapid evolution of telehealth platforms focused on managing chronic conditions as well as achieving
specific  patient outcomes ; the expansion of telehealth services offered by  private  and government operated healthcare systems (such as the  Veterans Administration ); and a new  direct-to-consumer initiative  by Samsung  and American Well.

However, the telehealth industry is still young. In many ways, today's telehealth industry is comparable to the Internet services industry, when the reigning speed of Internet access was 56.6 kbps. As far higher broadband speeds became the norm, entire industries were upended. Similarly, as the telehealth industry matures, healthcare delivery across our nation will experience disruptive shifts.

This article explores how telehealth will change the delivery of healthcare in the United States, and its impact on the
organization of many activities now provided by local hospitals and health systems throughout the nation.  Read  more here.
New Standards Aim to Improve Housing-First Models

The Joint Commission recently issued a report that offers an overview of behavioral healthcare accreditation standards for housing support services programs, applying to providers that use a "housing first" model. The standards, which took effect last July, do not require mental health and addiction treatment providers to engage clients in other services as a condition of their securing or remaining in housing.

Two leaders with the Joint Commission tell Behavioral Healthcare Executive that more than 150 accredited organizations, mostly community mental health centers and Department of Veterans Affairs (VA) sites, fall under the housing support services requirements. The standards apply to organizations already offering housing support services.

The accrediting organization's  R3 Report on the standards offers a basis for why the standards were established.

"The literature defines housing as a social determinant of health," says Peggy Lavin, the Joint Commission's senior associate director for behavioral health care accreditation. "The idea is that the burden of a housing problem is so extreme that the person cannot even think about addressing other problems."  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.