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February 17, 2016

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

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Francine Sinkoff, Editor
fs@clmhd.org
US Senate Committee Passes Comprehensive Addiction and Recovery Act (CARA)

The $77.9 million Comprehensive Addiction and Recovery Act (CARA) took a step forward today when the Senate Judiciary Committee voted unanimously to advance the measure. The bill, introduced a year ago by Sens. Sheldon Whitehouse (D-RI) and Rob Portman (R-Ohio), is co-sponsored by 28 bipartisan lawmakers.

According to the National Council for Behavioral Health, the operative word in CARA is "comprehensive." Use of naloxone, criminal justice reform and support for law enforcement are coupled with the treatment, prevention and recovery within the provisions.

CARA has a great deal of support in the industry, and according to GovTrack.us, no member of Congress has expressed outright opposition to it.  If it becomes law, CARA would:
  • Expand prevention and educational efforts-particularly aimed at teens, parents and other caretakers, and aging populations. 
  • Expand the availability of naloxone to law enforcement agencies and other first responders. 
  • Expand resources to identify and treat incarcerated individuals with addiction disorders promptly by collaborating with criminal justice stakeholders and by providing evidence-based treatment.
  • Expand disposal sites for unwanted prescription medications.
  • Launch an evidence-based opioid and heroin treatment and interventions program to expand training and resources for medication assisted treatment.
  • Strengthen prescription drug monitoring programs.
-Behavioral Healthcare Magazine, 2/11/16
CMS and Major Commercial Health Plans Announce Alignment and Simplification of Quality Measures for Medicare

Yesterday, the Centers for Medicare & Medicaid Services (CMS) and America's Health Insurance Plans (AHIP), as part of a broad Core Quality Measures Collaborative of health care system participants, released seven sets of clinical quality measures.   These measures support multi-payer alignment, for the first time, on core measures primarily for physician quality programs. This work is informing CMS's implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) through its measure development plan and required rulemaking, and is part of CMS's commitment to ensuring programs work for providers while keeping the focus on improved quality of care for patients.

Partners in the Collaborative recognize that physicians and other clinicians must currently report multiple quality measures to different entities. Measure requirements are often not aligned among payers, which has resulted in confusion and complexity for reporting providers. Read more here.
CMS:  Implementation of the Covered Outpatient Drug Final Regulation Provisions Regarding Reimbursement for Covered Outpatient Drugs in the Medicaid Program

Last week the Centers for Medicare & Medicaid Services (CMS) issued a letter to states providing guidance to the states concerning implementation of the Covered Outpatient Drug final rule with comment (CMS-2345-FC) (81 FR 5170) published on February 1, 2016, concerning final regulations pertaining to reimbursement for covered outpatient drugs in the Medicaid program. 

It outlines the key changes that states need to address when determining their reimbursement methodologies, including the revised requirement in 42 CFR §447.512(b) for states to reimburse at an aggregate upper limit based on actual acquisition cost (AAC) plus a professional dispensing fee established by the agency; the implementation of the Affordable Care Act federal upper limit (FUL); and requirements for the 340B entities, 340B contract pharmacies, Indian Health Service (IHS), Tribal, and Urban Indian Organization (I/T/U) pharmacies.
 
The letter is available here.
Confidentiality of Alcohol and Drug Abuse Patient Records: Proposed Revisions Open for Public Comment

HHS has published proposed revisions to the Confidentiality of Alcohol and Drug Abuse Patient Records regulations-42 CFR Part 2. The Notice of Proposed Rulemaking, titled "Confidentiality of Substance Use Disorder Patient Records," was published in the Federal Register on February 9, 2016. This proposal was prompted by the need to update and modernize the regulations.

The goal of the proposed changes is to facilitate information exchange within new health care models while addressing the legitimate privacy concerns of patients seeking treatment for a substance use disorder. The regulatory changes will ensure that patients with substance use disorders have the choice to participate in and benefit from new integrated health care models without fear of the risk of adverse consequences. 

HHS welcomes public comment on this proposed rule. To be assured consideration, comments must be received at the address provided below, no later than 5 pm Eastern Time on April 11, 2016. HHS will consider all comments received by the date and time specified, and will respond to the comments in the preamble of the final rule.  

Click here to submit comments online. More information can be found here.
European Assisted Suicide Study Questions Its Use for Mentally Ill

A new study of doctor-assisted death for people with mental disorders raises questions about the practice, finding that in more than half of approved cases, people declined treatment that could have helped, and that many cited loneliness as an important reason for wanting to die. The 
study, of cases in the Netherlands, should raise concerns for other countries debating where to draw the line when it comes to people's right to die, experts said.

At least three countries - the Netherlands, Belgium and Switzerland - allow assisted suicides for people who have severe psychiatric problems and others, like Canada, are debating such measures, citing the rights of people with untreatable mental illness. Laws in the United States, passed in five states, restrict doctor-assisted suicide to mentally competent adults with terminal illnesses only, not for disorders like
depression and schizophrenia.
The study, published Wednesday in the journal JAMA Psychiatry, finds that cases of doctor-assisted death for psychiatric reasons were not at all clear-cut, even in the Netherlands, the country with the longest tradition of carefully evaluating such end-of-life choices. People who got assistance to die often sought help from doctors they had not seen before, and many used what the study called a "mobile end-of-life clinic" - a nurse and a doctor, funded by a local euthanasia advocacy organization. Read more here.
UPCOMING TRAININGS

February 18, 2 - 3:15 pm, National Association of Counties

February 19, 1 - 2 pm, SAMHSA
 
February 25, 3 - 4:30 pm, SAMHSA-HRSA Center for Integrated Health Solutions

MCTAC
 
Transforming the Children's Medicaid System Webinar Series
 
CALENDAR OF EVENTS

FEBRUARY 2016
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
TBD

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 
President Obama Releases 2017 Budget Request; Includes New Behavioral Health Funding

President Obama on February 9th released the final budget request of his administration, reflecting an expansive vision of his legacy upon leaving office. Amid growing attention to the twin issues of mental health and addiction, the budget request includes $500 million for a series of two-year mental health initiatives and $1.1 billion for new addiction treatment, prevention and recovery programs. Overall, the Substance Abuse and Mental Health Services Administration request of $4.3 billion represents a $590 million increase from 2016.

Among the key provisions of interest to mental health and addiction providers across all Health and Human Service agencies are:
  • Excellence in Mental Health Act Expansion: As part of the President's $500 million mental health initiative, the budget request would add 6 additional states to the Certified Community Behavioral Health Clinic demonstration program, at an estimated cost of $110 million. The National Council has long advocated for the expansion of this important program and sees this as a step in the right direction in offering every American access to quality behavioral health care.
     
  • Behavioral Health IT: The budget request would add behavioral health providers to the federal Meaningful Use incentive program that supports providers in adopting health information technology. A long standing priority of the National Council's, the President's proposed expansion is similar to the Behavioral Health IT Act. Newly eligible providers include community mental health centers, residential and outpatient substance use treatment facilities, psychiatric hospitals, and psychologists.
     
  • Substance Abuse Prevention and Treatment Block Grant:  the budget requests $1.8 billion for the block grant, level to 2016 funding.
     
  • Mental Health First Aid: the budget requests $15 million for MHFA trainings, level to 2016 funding.
     
  • Primary Care Behavioral Health Integration: the budget requests $26 million for PBHCI, a $23 million cut from 2016.
     
  • Early intervention in serious mental illness: As part of the President's $500 million mental health initiative, the budget requests a new mandatory appropriation of $230 million over the next two years to provide evidence-based services to individuals experiencing the early onset of psychosis or other serious mental illnesses. Additionally, the budget request maintains the 10% early intervention set-aside enacted in the 2016 mental health block grant.
Read more here.
Join the New York State DSRIP Group on LinkedIn

The Medicaid Redesign Team (MRT) recently announced that they are transitioning the digital platform for DSRIP discussions from the MRT Innovation eXchange platform, known at the MIX, to a LinkedIn Group, called the New York State Delivery System Reform Incentive Payment (DSRIP) Program group. This new LinkedIn group will enhance connection and collaboration among DSRIP colleagues and stakeholders and allow for easy access and participation on key DSRIP topics and issues.
 
If you currently have a LinkedIn account, simply request to join the group by clicking HERE.

If you have any questions, please email MRT at dsrip@health.ny.gov.
Waiting Lists Grow for Medicine to Fight Opioid Addiction
BURLINGTON, Vermont - After more than a decade of getting high on illicit opioid painkillers and heroin every day, Christopher Dezotelle decided to quit. 

He saw too many people overdose and die. "I couldn't do that to my mom or my children," he said. He also got tired of having to commit crimes to pay for his habit - or at least the consequences of those crimes. At 33, he has spent more than 11 of his last 17 years incarcerated. The oldest of seven children, he started using marijuana and alcohol when he was 12.

It's been five years since Dezotelle started treatment the first time, and he still hustles for drugs every day. Only now, instead of heroin or OxyContin, he's trying to score buprenorphine, one of three federally approved opioid-addiction medications. He says heroin is much easier to find, and it's less than half the price of buprenorphine on the streets and parking lots of this college town.

Vermont Gov. Peter Shumlin, a Democrat, was among the first in the nation to address the opioid epidemic. He devoted his entire State of the State address to the crisis in 2014. Since then, his administration and many of Vermont's private practice doctors have made treatment more available than it is in most of the country.

But it's not enough.  In this state of about 626,000, almost 500 addicts are on waiting lists to receive medication for opioid dependence. More than half will wait close to a year.

Nationwide, a shortage of doctors willing to prescribe buprenorphine, which reduces drug cravings, and a federal limit on the number of patients they can treat, prevents many who could benefit from the addiction medication from getting it.

Less than half of the 2.2 million people who need treatment for opioid addiction are receiving it, U.S. Health and Human Services Secretary Sylvia Burwell said this month, previewing President Barack Obama's new budget, which was released Tuesday and proposes $1.1 billion to expand the availability of buprenorphine and other opioid-addiction medications.  Read more here.
How 'Mandatory Abstinence' Can Cut Crime and Save Lives

Few people who advocate for public health-oriented policies toward addiction look to the criminal justice system for inspiration. But a new study published recently in the medical journal Lancet Psychiatry may change that. RAND Corp. researchers showed that the implementation of an innovative program for alcohol-involved offenders was followed by a reduction in the population death rate that would do any addiction treatment system proud.

The program, called 24/7 Sobriety, was created in South Dakota by Larry Long, a former state attorney general who is now a judge. Faced with a steady stream of offenders who were repeatedly arrested for assault, driving while intoxicated and other alcohol-fueled crimes, Long conceived a radical alternative to business as usual: Sentence offenders to mandatory abstinence.

Every day in South Dakota, about 2,000 participants of 24/7 Sobriety are subject to monitoring by breathalyzers or alcohol-sensing bracelets. Those who drink are arrested immediately and suffer a swift but modest consequence, typically a night in the local jail. Of the 8.1 million scheduled breath tests mandated by the program over the past decade, offenders have shown up sober more than 99% of the time. The program has spread to other states and received federal funding in the massive transportation bill that President Obama signed two months ago.

Prior research by the RAND investigators suggested that 24/7 Sobriety delivers public safety benefits. In counties that adopted the program, repeat DUI arrests fell by 12%, and domestic violence arrests dropped by 9%. The just-released study looked beyond crime to ask a question more commonly associated with public health programs: Did the state's death rate decline because of 24/7 Sobriety?  Read more here.
Staying Sober After Treatment Ends

First of Two Parts from NY Times

Getting sober is hard. Making sobriety last is much harder. Most people who go into a residential rehab treatment manage to detox and stay that way during their weeks- or months-long stay. But problems begin when they leave. Many patients walk out the door - and fall off a cliff.

They go back to their old drinking or drug friends and places. The stresses of normal life resume. And exactly at the moment they need it most, they're essentially on their own.  It's hard to know how many people relapse, because usually no one tracks them - a problem in itself. But it's a lot. A survey (pdf) of studies looking at relapse rates found that only 46% of people who attended residential drug treatment stay in recovery. And about 40% of those had not managed complete abstinence.

Leaving rehab presents other dangers. The threat of overdose is greatest after a period of abstinence. The cravings remain, but spending time sober decreases drug tolerance, so a previously survivable dose can now be a killer. The same dangers apply to people newly released from jail or prison, if they did not have access to drugs inside (which many do).

The lack of resources for people when they are at their most vulnerable makes no sense. No doctor would help a patient control his blood sugar or blood pressure once - and then wave goodbye. The same should be true of addiction. It's a chronic disease that requires long-term, possibly lifetime, care. So why has care been so scarce?  Read more here.
Once A Pipe Dream, Disability Community Nearing Completion

LAKELAND, Fla. - Merely a pipe dream for the past 18 years, The Villages at Noah's Landing is nearing completion.

Quaint, colorful and secluded on 56 acres of semi-wooded prime real estate on Lake Crago in north Lakeland, the residential community for people with developmental or intellectual disabilities is unique for Polk County and a rarity throughout the nation.

The $17.5 million project is on schedule, having broken ground last February, and should see its first residents by late April or early May.

Financed primarily with low-income housing tax credits, the project is expected to alleviate a waiting list for safe, affordable housing for adults with disabilities such as autism, Down syndrome, Williams syndrome and cerebral palsy.  

Unlike state licensed group homes, Noah's Landing will operate independently, with oversight provided by staff, volunteers and parents, along with monitoring from state social workers.  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.

Affiliated