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January 6, 2016

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

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Francine Sinkoff, Editor

FUNDING OPPORTUNITY:  First-Ever CMS Innovation Center Pilot Project to Test Improving Patients' Health by Addressing Their Social Needs

Many of the biggest drivers of health and health care costs are beyond the scope of health care alone. Health-related social needs often are left undetected and unaddressed. Unmet health-related social needs, such as food insecurity and inadequate or unstable housing, may increase the risk of developing chronic conditions, reduce an individuals' ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization.

The Centers for Medicare & Medicaid Services (CMS) has announced an Accountable Health Communities (AHC) model to address a critical gap between clinical care and community services in the current delivery system. The AHC model will test whether increased awareness of and access to services addressing health-related social needs will impact total health care costs and improve health and quality of care for Medicare and Medicaid beneficiaries in targeted communities.

For more information about this funding opportunity click here.
HCBS Implementation Delayed for Rest of State to October

The timeline for the implementation of Behavioral Health Home and Community Based Services (BH HCBS) for the HARP population in the rest of the State has been delayed from July 1, 2016 to October 1, 2016 to follow the implementation timeline for NYC which allowed a 3-month time period between the implementation of non-HCBS behavioral health services in Mainstream Plans and HARPs and the implementation of BH HCBS.


The date of the implementation of non-HCBS behavioral health services in managed care in Rest of State has not changed and is on schedule for July 1, 2016.


For more information about the timeline for the behavioral health transition to managed care, please click here.

October 2015 CMS Medicaid & CHIP Eligibility and Enrollment Report

According to CMS's monthly Medicaid/
CHIP eligibility and enrollment report, 71.8 million individuals were enrolled in Medicaid and CHIP in October 2015. Nearly 187,958 additional individuals have enrolled in Medicaid and CHIP since September 2015. Click here for the report.
CMCS Updates New Core Quality Measures for Medicaid, CHIP

Earlier this month, the Center for Medicaid and Children's Health Insurance Program Services (CMCS) published an update to core quality measures for adults and children enrolled in Medicaid and CHIP. The core measures are tools states can use to monitor and improve the quality of services provided to the Medicaid and CHIP population. The new measures will take effect no later than December, 2016.

In 2011, CMCS created two core sets of measures to monitor the quality of services in Medicaid and CHIP: the Child Core Set and the Adult Core Set. The goal of these core sets is to encourage national reporting by states on a uniform set of measures and support states in using these measures to drive quality improvement. Of particular importance to behavioral health stakeholders, is the addition of new opioid-related measures for 2016.


To the Child Core Set, CMCS will begin tracking the use of multiple concurrent antipsychotics in children and adolescents. To the Adult Core Set, CMCS will begin monitoring the use of opioids from multiple providers at high dosage in patients without cancer as well as monitoring diabetes screenings for individuals with schizophrenia or bipolar disorder who are using antipsychotic medications.


To aid states in implementing these changes, CMCS will be releasing technical supporting documents in the spring. The National Council will share these documents when they become available. For more information on CMCS reporting requirements, click here.

IMPORTANT from CMS on Health Homes:  Updates to Health Home Information Resource Center Webpage

The Centers for Medicare & Medicaid Services (CMS) released a set of Frequently Asked Questions (FAQs) regarding the Health Home Medicaid State Plan Option authorized under Section 1945 of the Social Security Act.  The information is posted to the Health Home (HH) Information Resource Center webpage on  In addition to the FAQs, other new documents have been added that include: HH Map; HH Fact Sheet; HH State Plan Amendment (SPA) Overview by state; and a List of Chronic Conditions Targeted by approved HH States.
The FAQ document can be found by clicking here.
The HH Information Resource Center Home Page is located here.
Patients' High Risk for Nicotine Dependence Requires More Attention

It has been reported that people who have alcohol and drug use disorders and enter addiction treatment programs smoke cigarettes at rates around four times the rate of smoking in the general population, and get sick and die from tobacco use at high rates as well. Why? What explains this? What is the "vulnerabilty factor"?

Whatever the cause(s) of this vulnerability, the compelling facts are that this particular population of Americans crossing racial, cultural and class lines is dying at an astonishing rate without much attention to that reality. The revelation that we don't appear to have a satisfactory explanation for this discrepancy is new to most in the public health field.

Studies from New York and Wisconsin indicate that patients entering addiction treatment services have a nicotine dependence (tobacco use disorder) in extremely high numbers. New York state reviewed 100,000 admissions to its addiction treatment programs and discovered that 92% of patients met nicotine dependence diagnostic criteria. A study of 52 residential and day treatment programs at the St. Clare Center in Baraboo, Wis., revealed that 85% of patients met nicotine dependence criteria.

The World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) have determined that half of those who smoke into middle age (or for 20 years) will die from tobacco-caused or -related diseases. Others who don't die from tobacco use have a reduced quality of life and poorer health.  Read more here.
Impact of Legal Marijuana on Alcohol Use Still Unknown

The legalization of recreational marijuana in some states has stimulated research to assess the impact of legal marijuana on the consumption of alcohol.

A team of investigators from the University of Washington have published their initial findings online in the journal Alcoholism: Clinical & Experimental Research. A clear cut answer, unfortunately, remains elusive as the study highlights the difficulties of gauging the impact of a formerly illicit drug as it moves into the mainstream.

Recreational marijuana use is now legal in four states and medical marijuana in 23 states. Drinking alcohol is a common pursuit in the U.S. as a majority of adults drink to varying degrees. Alcohol abuse is the third leading preventable cause of death nationwide. Drinking accounts for almost one-third of driving fatalities annually, and excessive alcohol use cost $223.5 billion in 2006 alone.

In the study, the researchers sought to determine whether legalizing marijuana led to it becoming a substitute for alcohol, or if smoking pot increased consumption of both substances.  If it was the former, they reasoned, that could greatly reduce the costs of healthcare, traffic accidents, and lower workplace productivity related to excessive drinking. But if legalized marijuana resulted in increased use of both drugs, costs to society could increase dramatically. This could happen if those who use both substances use them at the same time.  Read more here.


January 15, 2 - 3:30 pm, National Reentry Resource Center.


Mental Hygiene Planning Committee 
January 7:  11 am - 1 pm

Children & Families Committee
January 12:  11:30 am - 1 pm
41 State St., Ste. 505, Albany

CLMHD Directors Meeting
January 19:  9:30 am - 11 am
GTM Only

CLMHD Executive Committee Meeting
January 19:  11 am - 12:30 pm
GTM Only

CLMHD Mentoring Workshop
January 26:  11:30 am - 12:30 pm

Developmental Disabilities Committee Meeting
January 27:  11 am - 12:00 pm
GTM Only

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
Dutchess County Crisis Center Aims to Reduce ER Visits, Jail Rates

Karen Zirbel has always felt her verbal skills have been an important tool in her 11-year career as a City of Poughkeepsie police officer.  It was while responding to a call of a suicidal homeless man a few months ago that she saw just how beneficial these skills could be.  The man had threatened the life of some of his coworkers as well as himself. City police located him in the woods, but instead of rounding him up to take him to the local hospital, they spent time talking with him first.

"We took the extra step. I sat down...he just wanted someone to listen to him," Zirbel said. "And a lot of times, that's what most of it is. They just want to be heard."
Proper communication techniques with mental health patients and substance abusers is a key component to the 
Crisis Intervention Training, which is one of the tools Dutchess County has instituted in an effort to overhaul how mental health and substance abuse situations are dealt with on the streets, in emergency situations and within incarceration.

Another tool will be a 24-hour Crisis Stabilization Center that will serve as a voluntary walk-in or police drop-off for individuals suffering from mental illness or substance abuse. A $4.8 million bond recently was approved to renovate the county's Mental Hygiene buildings at 230 North Road in Poughkeepsie into the center.
The goals of the center are to provide more humane treatment of mentally ill and substance abusers, while encouraging collaboration among health care providers, law enforcement and others. It aims to reduce avoidable hospital visits by 25 percent within five years. County officials have said they hope to drive down the overall jail population by instituting the center, but say they haven't set specific goals.  Read more here.
New Programs and Provider Models Help Inmates in Transition

America's jails and prisons have replaced psychiatric hospitals as warehouses for people with mental illness. Substance abuse disorders also abound, but innovative healthcare models and other advances are helping to confront the crisis in our nation's correctional facilities.

About 15% of men and 31% of women in jails are affected by serious mental illness, according to the Council of State Governments' Justice Center.  The crisis of mentally ill individuals flooding prisons is a "common-sense problem," according to Roy Austin, JD, deputy assistant to the President for the Office of Urban Affairs, Justice and Opportunity. Austin spoke last week in Washington at a conference on criminal justice reform hosted by the Washington-based National Council for Behavioral Health, and by Community Oriented Correctional Health Services (COCHS) of Oakland, Calif.

"We know for a fact that we are incarcerating people who are having mental health issues. And we know for a fact that we are not providing them with the treatment that they need so that they can be successful when they come out," Austin said, adding that the "common-sense solution" is the Excellence in Mental Health Act.  Its purpose is to establish criteria and funding for the development of federally qualified behavioral health centers, also known as certified community behavioral health centers or CCBHCs.

Co-sponsored by senators Debbie Stabenow (D-Mich.) and Roy Blunt (R-Mo.) and signed into law April 2014, the legislation allocates $1 billion in Medicaid dollars to CCBHCs. Twenty-four states have received grants to aid in planning the development of such CCBHCs. Late next year, eight of the 24 states will be chosen to participate in the demonstration project.  The care teams are unique in that they operate outside of traditional settings. They can visit jails, arraignment courts, foster homes, and halfway houses, helping to divert people who should be receiving treatment instead of being incarcerated into the proper setting. They will also coordinate care services for those leaving the prison system.  Read more here.
Opioid Addiction Treatment Argued as 'Essential' Insurance Benefit

Physicians, social workers and consumer advocacy groups are putting pressure on the CMS to require all health plans sold on the federal exchange to cover medications used to treat people with opioid addictions.

More than 28,600 people died in 2014 due to overdoses from prescription painkillers, heroin and other opioids, according to a recent analysis from the Centers for Disease Control and PreventionNumerous hospital associations, psychiatrists, primary-care physicians, executives at drug-abuse treatment centers and recovering opioid addicts supported the idea in comments to the CMS this week, although several large insurers and pharmacy benefit management companies argued the benefit should be left up to their discretion.

The Affordable Care Act requires health insurers to cover 10 essential health benefits, including prescription drugs and substance use disorder services, but it has been unclear whether plans on the federal marketplace had to cover the full range of medication-assisted treatment. Many commercial insurers pay for MAT, a therapy where people take medication and counseling to reduce their cravings for opioids.

The Substance Abuse and Mental Health Services Administration and National Institute on Drug Abuse have found MAT to be effective for people suffering from opioid addiction. NIDA said MAT "increases patient retention and decreases drug use, infectious disease transmission and criminal activity," and it also saves money by keeping people out of hospitals and outpatient centers.

But some physicians and patient advocates say insurance companies have instituted high copays and other barriers that result in inadequate coverage for the treatment. Methadone and buprenorphine, the two most common drugs used in MAT, could cost someone thousands of dollars per year out of pocket. Read more here.
Many Continue to Receive Opioid Prescriptions After Overdose

Almost all people who overdose on prescription opioids continue to receive prescriptions for these painkillers, according to a new study.

"We found the results both surprising and concerning," said lead author Dr. Marc R. Larochelle of Boston Medical Center.

"While this study wasn't designed to answer why, one possibility is that providers are not aware that their patients experienced an overdose when making the decision to continue prescribing opioids," Larochelle told Reuters Health by email. "This lack of knowledge may be a symptom of our fragmented health care system where there is no clear mechanism to communicate events from emergency department or inpatient settings to providers in the community."

The researchers used Optum, a national commercial insurance claims database, to identify almost 3,000 patients who experienced a nonfatal overdose between 2000 and 2012 while taking long-term opioids prescribed for chronic pain not related to cancer. Opioids include drugs like codeine, oxycodone, hydrocodone, hydromorphone, and tramadol.

Just over 90% of these patients continued to receive prescription opioids after the overdose. More than half got the prescription from the same doctor.

Past providers could theoretically be identified through prescription monitoring programs or insurance claims data and notified of an overdose, but there is no way to notify other providers, Larochelle said.

There were 212 second overdoses, 7% of the original group.  Read more here.
National Survey of Compensation Among Peer Support Specialists

The College for Behavioral Health Leadership conducted a national survey to determine the prevailing wages for peer specialists.  Two surveys were constructed and included peer support specialists, and organizations that employ them.  Over 1,600 individuals responded to the survey and more than 270 organizations also participated.  

The findings of this study illustrate diversity among the current national structures for the wages of peer specialists. This includes significant differences in average compensation rates between those who work all different hours ($15.42) and only full-time ($16.36). There are also different wage rates among the types of organizations (consumer and peer run organizations; community behavioral health organizations; health care provider organizations; inpatient psychiatric facilities; and health plan and managed care organizations) that employ this workforce. An analysis of the wages of peer specialists in the 10 US Department of Health and Human Services regions also demonstrates geographic differences in compensation rates and compares regional and national averages. Inequities in compensation rates are also noted between male and female peer specialists, with men receiving on average in excess of $2.00 more per hour than women. The implications for the findings of this study are discussed and include the need for greater attention and focus on the wages of the peer specialist workforce.

The survey report has been published as an ACMHA white paper and is available by clicking here.
Programs Expand Schizophrenic Patients' Role in Their Own Care

The idea was to go out in an emotional swan dive, a lunge for the afterlife that would stretch his 17-year-old imagination. He settled on a plan and shared the details with a Facebook friend: He would drop DMT, a powerful psychedelic, and then cut his throat.

"Everyone was telling me what I could and couldn't do - doctors, my parents," said Frank, now a 19-year-old college student. "I was going to hurt myself, to show people, 'Look, I am still in control of my life.'"

And so, in time, he was. Frank, who eight months earlier had received a diagnosis of psychosis, the signature symptom of schizophrenia, and had been in and out of the hospital, gradually learned to take charge of his own recovery, in a new approach to treatment for people experiencing a first psychotic "break" with reality.
More than two million people in the United States have received a diagnosis of schizophrenia. Most are consigned to whatever treatment is available amid a hodgepodge of programs that often focus on antipsychotic drugs to blunt delusions and paranoia - medicines that can come with side effects so debilitating that many patients go off them and end up in a loop of hospitalization and despair.

But over the past several years, a number of states have set up programs with a different approach, emphasizing supportive services, like sustained one-on-one therapy, school and work assistance, and family education, as well as medication. The therapists work to engage each patient as an equal partner in decisions - including about medication dosage, to make it as tolerable as possible.

In a landmark study published this fall, government-backed researchers reported that after two years, people who had this combined package were doing better on a variety of measures than those who received treatment as usual. The difference was modest but notable. And, significantly, the participants continued to receive care for six months longer on average.  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.