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January 27, 2016

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

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Francine Sinkoff, Editor

November 2015 CMS Medicaid & CHIP Eligibility and Enrollment Report

According to CMS's monthly Medicaid/
CHIP eligibility and enrollment report, 70.8 million individuals were enrolled in Medicaid and CHIP in November 2015. Nearly 274,893 additional individuals have enrolled in Medicaid and CHIP since October 2015. Click here for the report.
State Considerations for Implementing Integrated Care Programs for Dually Eligible Individuals: New Briefs

A number of states are seeking to integrate care for dually eligible individuals through demonstrations under the Financial Alignment Initiative and contracts with Medicare Advantage Dual-Eligible Special Needs Plans. In implementing these programs, states must ensure that they operate as intended, attract and retain enrollment, and succeed over the long term. Two new briefs, developed through support from The Commonwealth Fund and The SCAN Foundation, address key considerations for states in implementing successful integrated care approaches.
Interdisciplinary Care Teams for Medicare-Medicaid Enrollees: Considerations for States examines strategies for developing interdisciplinary care teams (ICTs), an important component of integrated care programs. Members of ICTs work collaboratively to develop and implement care plans that meet individuals' medical,
behavioral, long-term care, and social service needs. Considerations for effective teams include: how prescriptive to make ICT requirements; how ICTs can better engage providers and hard-to-reach individuals; and how to measure ICT performance. This brief describes key ICT considerations and explores how eight states -- Idaho, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, Virginia, and Washington -- addressed these issues. 
Communicating Early Results of Integrated Care Efforts for Dually Eligible Individuals: State Approaches examines how states implementing integrated care programs are sharing early achievements with stakeholders to maintain support and encourage enrollment. The brief describes how seven states -- Arizona, California, Florida, Massachusetts, South Carolina, Texas, and Virginia -- communicated initial program results including: (1) developing key program indicator dashboards; (2) disseminating beneficiary experience data; and (3) sharing of success stories. 
The lessons in these briefs can assist states, health plans, providers, consumers, and other stakeholders in advancing more effective integrated care programs for dually eligible individuals.
SAMHSA Funding Opportunity: National Child Traumatic Stress Initiative - Category III Community Treatment and Services (CTS) Centers

SAMHSA is accepting applications for its National Child Traumatic Stress Initiative-Category III Community Treatment and Services Centers. This program aims to provide and increase access to effective trauma-focused treatment and services systems in communities for children, adolescents, and their families who experience traumatic events.  
This initiative's work is carried out by a national network of grantees-the National Child Traumatic Stress Network (NCTSN)-who works collaboratively to develop and promote effective trauma treatment, services, and other resources for children, adolescents, and families exposed to an array of traumatic events. The NCTSN members collaborate with one another, and partner with systems of care where children, adolescents, and families who have experienced trauma receive services in their communities.
  • Anticipated Total Available Funding: $22,400,000
  • Anticipated Number of Awards: 56
  • Anticipated Award Amount:  Up to $400,000
  • Length of Project: Up to 5 years
Eligible applicants are domestic public and private nonprofit entities.  For example:
  • State and local governments
  • Federally recognized American Indian/Alaska Native (AI/AN) tribes and tribal organizations
  • Urban Indian organizations
  • Public or private universities and colleges
  • Community- and faith-based organizations
Applications are due by Thursday, Feb. 4. Learn more and apply.
Synthetic marijuana cost NY taxpayers more than $22M in hospital, jail expenses in 2015

The popularity of synthetic marijuana cost state taxpayers more than $22.7 million in hospital and jail expenses in 2015, according to a report.

The study estimated costs tied to the more than 6,000 state residents who were hospitalized due to the dangerous use of the drug, including 700 people in the Bronx. All told, 68% of the mostly male patients were covered by publicly funded Medicaid.

The 19-page "The State of Synthetics" report was commissioned by a group of state lawmakers seeking a ban of the faux weed frequently sold as incense.
"Most people don't realize the tremendous financial impact from this public health crisis," said state Sen. Jeffrey Klein, a Democrat who represents parts of the Bronx and Westchester.

K2, also known as spice, has become increasingly prevalent due to its low cost and easy accessibility at bodegas throughout the city, as well as on eBay. 
Read more here.



February 2, 3 - 4 pm

February 3, 12 - 1 pm

Transforming the Children's Medicaid System Webinar Series: January 27-February 25, 2016

Register now for a 3-part webinar series hosted and presented by MCTAC, DOH, OMH, OASAS and OCFS!

This series is intended for OMH, OASAS, and OCFS child-serving providers and stakeholders impacted by and interested in medicaid managed care, kids HCBS (home and community based services), and new state plan services. This webinar series will not specifically address details of the children's Health Home transition. 

This series will be divided into three parts and will be recorded and posted to the MCTAC website for those who are unable to attend. We encourage you to call together your staff to listen and discuss the transformation before us.Register now using the links below for each individual webinar: 

January 27, 12:30 - 1:30 pm

February 11, 12 - 1 pm

February 25, 12 - 1 pm


Officers & Chairs - Call in
February 10:  8 am

CLMHD Office Closed - Lincoln's Birthday
February 12 

CLMHD Office Closed - Washington's Birthday
February 15

Children & Families Committee
February 16:  11:30 am - 1 pm

OMH Agency Meeting
February 22:  10 am - 12 pm
44 Holland Ave., 8th Fl, Albany

OASAS Agency Meeting
February 22:  1 pm - 3 pm
1450 Western Ave., 4th Fl, Albany

MARCH 2016
Officers & Chairs - Call In
March 2:  8 am

Mental Hygiene Planning - In Person
March 3:  11 am - 2 pm
Syracuse, NY

Children & Families Committee
March 15:  11 am - 12 pm

Director's Meeting - In Person
March 22:  10:30 am - 12 pm
41 State St., Ste. 505, Albany

Executive Committee - In Person
March 22:  12:30 - 2 pm
41 State St., Ste. 505, Albany

Developmental Disabilities Meeting
March 30:  11 am - 12 pm
GTM Only

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
Assembly Report: Lack of Treatment Hurts Heroin Fight

Lack of treatment
options are the biggest roadblock to turning the tide against the heroin epidemic in New York state, a state Assembly Republican task force concluded in a report released Monday. 

"The Heroin Epidemic: A Report on Heroin Use, Treatment, Prevention & Education Efforts in NYS" paints a picture of frustration from all corners. Law enforcement officers, health care providers, rehabilitation specialists and, most of all, concerned loved ones from all corners of the state gave testimony illustrating the difficulty of obtaining meaningful treatment for people addicted to opioids. 

And, the report noted, where services are available, connecting the dots between the various programs is too often left up to families - or the addicts themselves. 

"Presently detoxification, rehabilitation, and recovery are treated as three separate and decoupled programs. It became apparent during the course of the forums that these three phases must work hand-in-hand and in conjunction with one another to facilitate successful treatment for addiction," the report concluded. 

Furthermore, many expressed frustration with a "fail first" model of rehabilitation, which requires that addicts first go through outpatient treatment as many as three times before being admitted to an inpatient facility.
The task force is recommending a "HELP Plan" (Heroin Elimination and Prevention) that aims to address deficiencies in the state's ability to combat heroin use and addiction. Read more here.
Gun Violence: Is Obama Right To Cite Mental Illness?

Article by 
Paul Applebaum, M.D., Director, Division of Law, Ethics and Psychiatry at Columbia and 
Jeffrey A. Lieberman, M.D., Chairman, Department of Psychiatry and Director, NYSPI

In response to the onslaught of repeated shootings across the United States and a demonstrated frustration at the lack of congressional action following the tragedy at Sandy Hook Elementary in December 2012, President Obama announced a package of executive actions aimed at reducing gun violence.
His orders contained helpful measures to restrict access to and improve the safety of firearms.  A larger number of gun dealers will have to get federal licenses and conduct background checks on their customers.
The FBI will receive 230 additional positions to ensure that background checks can be completed within the three-day window mandated by law.  Research on new technologies to make guns safer - for example, by recognizing their owners - will be accelerated and promises to reduce accidents and theft.
Incongruously, however, the president's statement also included initiatives directed
at people with mental illness, including requesting $500 million in funding from Congress to improve access to mental health treatment (something that should not require violent tragedies to be done).
In addition, the administration issued regulations clarifying that the Health Insurance Portability and Accountability Act (HIPAA) - the federal medical privacy law - would not prevent states from reporting persons who were involuntarily hospitalized in psychiatric facilities to the National Instant Criminal Background Check System (NICS) and therefore ineligible to possess guns.
Furthermore, the president indicated that the Social Security Administration would begin working on procedures to report to the NICS beneficiaries disabled by mental illness who are found to be unable to manage their own funds.
While additional funding for mental health services is welcome, it is concerning that provisions related to people with mental illness are included in a package of initiatives aimed at reducing gun violence.
The president appears to be pandering to the large proportion of Americans who believe that the problem of gun violence is largely due to people with mental illness. The fact that many people hold this view is hardly surprising given that the National Rifle Association and other gun rights groups have hammered it home repeatedly, after every incident of mass violence.
But it could not be further from the truth. Read more here.
Massachusetts Chief's Tack in Drug War: Steer Addicts to Rehab, Not Jail

Leonard Campanello, the police chief of Gloucester, Mass., took the microphone here in mid-December and opened with his usual warm-up line: I'm from Gloucester, he said in his heavy Boston accent. "That's spelled 'G-l-o-s-t-a-h.'"

A casually profane man with a philosophical bent, Chief Campanello, 48, first drew national attention last spring when he wrote on Facebook that the old war on drugs was lost and over. Convinced that addiction is a disease, not a crime or moral failing, he became the unusual law enforcement officer offering heroin users an alternative to prison.

"Any addict who walks into the police station with the remainder of their drug equipment (needles, etc.) or drugs and asks for help will NOT be charged," he wrote. "Instead we will walk them through the system toward detox and recovery" and send them for treatment "on the spot."

Critics said that he did not have the authority to take the law into his own hands and forgo arrests. But other police departments, fed up with arresting addicts and getting nowhere, saw the Gloucester approach as a promising way to address the epidemic of heroin and prescription pain pills, which together killed 47,055 people in 2014 nationwide - more than died in car accidents, homicides or suicides. Read more here.
Opioid Abuse Takes A Toll On Workers And Their Employers

Three decades ago, the treatment Michele Zumwalt received for severe headaches involved a shot of the opioid Demerol. Very quickly, Zumwalt says, she would get headaches if she didn't get her shot. Then she began having seizures, and her doctor considered stopping the medication.

"I didn't know I was addicted, but I just knew that it was like you were going to ask me to live in a world without oxygen," she says. "It was that scary."

Zumwalt didn't cut back. In fact, over two decades, the Sacramento, Calif., resident got an ever-increasing number of opioid prescriptions - all while working in corporate sales.

"I could show up at Xerox and put on a presentation, and I was high on Percodan," she recalls. "I mean, fully out of it. I don't know how many I had taken, but so many that I don't remember the presentation. And do you know that people didn't know?"

Her addiction worsened, eventually forcing her to take medical leave. Now sober for a dozen years, Zumwalt wrote a book about recovery called Ruby Shoes.

Her story highlights, among other things, the many challenges employers face in dealing with prescription drug abuse.

According to one study, prescription opioid abuse alone cost employers more than $25 billion in 2007. Other studies show people with addictions are far more likely to be sick or absent, or to use workers' compensation benefits.

When it comes to workers' comp, opioids are frequently prescribed when pain relievers are called for. How often doctors choose opioids varies by state; an analysis found the highest rates in Arkansas and Louisiana.  Read more here.
Long-Term Opioid Use Linked To This Mental Health Problem

People who take prescription opioids, which are used for treating pain, for longer than a month may have an increased risk of developing depression, according to a new study.  Pain itself can also lead to depression, but in the study, the link between depression and opioid use held even when the researchers accounted for the potential contribution of pain to depression, according to the study.

Therefore, if people who are taking opioids for pain notice they have been feeling depressed, both they and their doctors should be aware that the use of the drugs, and not just the pain, may be a potential source of the depressed mood, the researchers said.

"We really did rigorous control for pain, and we feel strongly that these results are independent of the known contribution of pain to depression," said study author Jeffrey Scherrer, an associate professor of family and community medicine at Saint Louis University in Missouri. 

In the study, the researchers looked at data from three large groups of people who started taking opioids around the time the study started. The first group had nearly 71,000 people; the second had nearly 14,000 people; and the third had nearly 23,000 people. The ages of the people in the study ranged from 18 to 80 years.

The people did not have depression at the start of the study. The researchers followed up with the participants for seven to 10 years, depending on which group the people were in.  The researchers found that 12% of the nearly 71,000 people in the first group, 9% of the nearly 14,000 people in the second group and 11% of the nearly 23,000 people in the third group had developed depression 
during this time.  Read more here.
E.R. Visits Up for Young Adults with Mental Illness

While emergency department visits for young adults ages 19 to 25 decreased slightly overall following the implementation of the Affordable Care Act (ACA), visits for mental illnesses in this age group increased "significantly," as did diseases of the circulatory system, according to a study published online this month in 
Annals of Emergency Medicine.

"Increased health insurance coverage reduced ER visits by young people for conditions that can be treated in office-based settings, but the lack of mental health resources continues to bring these patients to the ER in ever larger numbers," said study author Renee Hsia, MD, of the University of California San Francisco. 

Researchers conducted a before and after study of patient visits to emergency departments in California, Florida and New York to determine whether the ACA had an impact on those visits. Patients age 19 to 25 were compared to patients 26 to31 over the same time periods (September 2009 through August 2010 versus January through December 2011).  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.