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January 25, 2017

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

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Francine Sinkoff, Editor

SAMHSA's GAINS Center Now Accepting Applications for Sequential Intercept Mapping (SIM) Workshops

SAMHSA's GAINS Center is currently soliciting applications from communities interested in developing integrated strategies to better identify and respond to the needs of adults with co-occurring mental health and substance use disorders in contact with the criminal justice system. Sequential Intercept Mapping (SIM) is a 1.5-day workshop designed to allow local, multidisciplinary teams of people from jurisdictions to facilitate collaboration and to identify and discuss ways in which barriers between the criminal justice, mental health, and substance use systems can be reduced and to begin development of integrated local plans.  

SAMHSA's GAINS Center will offer this workshop free of charge in selected communities between May and August 2017. There are no fees for registration, tuition, or materials associated with these workshops. The GAINS Center will pay all costs associated with pre- and post-workshop coordination, conference calls, and facilitator time and travel.

To apply for a 2017 SIM workshop, please click here to download the solicitation and submit a completed application form no later than February 24, 2017
Tackling Patients' Social Problems Can Cut Health Costs

Donning a protective gown, rubber gloves and a face mask, Dayna Gurley looks like she's heading into surgery. But Gurley is a medical social worker charged with figuring out why her client, a man who uses more health care services than almost anyone else in Houston, has been in three different hospitals in the last month.

The patient, who asked not to be identified, has chronic massive ulcers, AIDS and auditory hallucinations. He rents a cot in another person's home but is more often homeless, with no family to help him.

"It's almost like self-sabotage," Gurley said about her many attempts to steady her client's life. "We get really close to an important doctor's appointment or getting him connected with stable housing, and his impulsiveness gets in the way of that."

Patients like the Houston man are health care's so-called "super-utilizers"- people with complex problems who frequent emergency rooms for ailments more aptly handled by primary care doctors and social workers. They cost public and private insurers dearly - making up just five percent of the U.S. population, but accounting  for 50 percent of health care spending.

As health care costs continue to rise, hospitals and doctors are trying to figure out how to find these patients and get to the root of their problems.  Read more here.
New DSRIP Whiteboard Videos

The Medicaid Redesign Team (MRT) recently announced two of the latest installments in its NYS Delivery System Reform Incentive Payment (DSRIP) Program whiteboard video series.  The first video, titled, "  DSRIP: Looking Ahead to 2017"  includes  information from NYS Medicaid Director, Jason Helgerson,  about what is ahead for the Delivery System Reform Incentive Payment (DSRIP) Program in 2017, including the importance of the mid-point assessment. He also describes how Value Based Payment (VBP) will fit into and align with DSRIP and how it effects Medicaid in general in 2017.

The second video, titled, " Myths and Facts of Value Based Payment," discusses common myths and facts about the Value Based Payment (VBP) initiative. Here, Jason Helgerson debunks common misunderstandings about the program and promotes the facts of what VBP actually means to those who are and will be participating in it.
Visit for more information about DSRIP. 

February 8, 12 - 1 pm

February 17, 1 - 2 pm


February 2, 2 - 3 pm,  National Reentry Resource Center

February 9, 12 - 1 pm, CMS Innovation Center



RPC Leads & Coordinators Call
January 26:  8 - 9 am,  GTM


Officers, Chairs & Regional Reps Call
February 1:  8 - 9 am,  GTM

RPC Leads & Coordinators Call
February 9:  8 - 9 am,  GTM

OMH Agency Meeting
February 13:  10 am - 12 pm
44 Holland Ave., 8th Fl., Albany

OASAS Agency Meeting
February 13:  1 - 3 pm
1450 Western Ave., 4th Fl., Albany

Children & Families Committee
February 21:  11:30 am - 1 pm, GTM

RPC Leads & Coordinators Call
February 23:  8 - 9 am,  GTM

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
New York State Selected for Federal Program to Develop Certified Community Behavioral Health Clinics (CCBHC)

The New York State Office of Mental Health, the Office of Alcoholism and Substance Abuse Services and the Department of Health today announced that New York has been selected to participate in a two-year demonstration program to better integrate community-based physical and behavioral healthcare services and promote access to improved primary care, mental health, and substance-use disorder services.

New York is one of only eight states selected to participate in the demonstration phase of this federal initiative, awarded by Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Medicare and Medicaid Services (CMS). New York was originally one of  twenty-four states selected to receive planning grants in the winter of 2015, to strengthen community-based mental health care and substance use disorder programs through the development of new Certified Community Behavioral Health Clinics (CCBHC) in pilot sites across the state. R ead more here .
How Block Grants Cap Federal Costs -- and Make States the Cost-Cutting Bad Guys

It didn't take long for President-elect Donald Trump and his senior advisers to begin backing away from Trump's promise to provide "insurance for everybody" as part of his incoming administration's evolving plan to repeal and replace the Affordable Care Act.

Without ever explaining precisely what he had in mind, Trump told  The Washington Post last weekend that he would push for something resembling universal coverage that would insure even more than the 20 million Americans who currently benefit from Obamacare.

Trump's boasting that he was on the verge of unveiling a comprehensive health care plan to replace Obamacare that would offer cheaper premiums, better choices for consumers and near universal coverage caught congressional Republicans by surprise. The billionaire businessman's boast has highly complicated their effort to devise a realistic plan that can win the support of rank and file lawmakers, the health care and insurance industries and a nervous public.

Even Rep. Tom Price (R-GA), Trump's choice to head the Department of Health and Human Services was vague during his Senate confirmation hearing Wednesday on how many more people would receive coverage once the Republicans fully overhaul the health care system. Price promised Americans "access" to the highest quality care and coverage possible but offered no guarantees that everyone could afford it.  Read more here.
Feds Pick Orange County DA for New Drug Treatment Program
The Bureau of Justice Assistance has chosen the Orange County District Attorney's Office for training and technical assistance geared toward developing a different kind of drug diversion program, one led by prosecutors.

"They gave out five of these technical assistance awards, and we got one," District Attorney David Hoovler said.   Other recipients are Dallas, Texas; Santa Barbara, Calif.; Deschutes County, Ore.; and the Fourth Circuit  Court District in Mississippi.

Robert Conflitti, counsel to the district attorney, went to Phoenix, Ariz., to see prosecution-led diversion in action. Conflitti said these programs are in place in some large cities, and BJA and the Center for Court Innovation want to see how something similar might work in smaller jurisdictions. The BJA assistance provides experts to help Orange County try to devise a program that will work here.
Hoovler said existing diversion courts are not set up to specifically address the mental health issues of many defendants, and there's a backlog of people waiting for diversion court slots. Hoovler said he wants to set up a program that will bring together Orange County's 20 towns, 19 villages and three cities under a unified approach.
"I wanted something to be able to get people to treatment quicker than having to go through the court process," he said.
Hoovler said his office has already brought in Orange County Mental Health and Social Services, the Alcoholism and Drug Abuse Council of Orange County (ADAC), Cornerstone Family Health Care and St. Luke's Cornwall Hospital, and all support the initiative. Other providers will be added as the project moves along.  Read more here.
SAMHSA Report:  Crossover of Mental Health and Opioid Misuse Equals 1.5 Million Adults

A new  report   by SAMHSA indicates that in 2015 about 1.5 million adults who had experienced a serious mental illness in the past year had also misused an opioid during this period. The data comes from SAMHSA's National Survey on Drug Use and Health.

In the population of those with serious mental illness, more than 15% had also misused opioids, meanwhile, in the population of those misusing opioids, 13% also reported serious mental illness.

In terms of the larger U.S. population, about 4% of all adults had serious mental illness in the past year and 4.8% of all adults misused opioids in the past year, which includes prescription pain drugs and heroin.
Building Your Own Definition Of 'Value'

Last week, OPEN MINDS Vice President Paul Block, Ph.D. talked about the challenges of getting health plan contracts - especially in a value-based market. His solution was to document your program's clinical outcomes and financial impact - and then be assertive about proposing those models to health plans (see  Have 'The Best' Services, But No Health Plan Contracts? ). I agree with Paul's recommendations - but for organizations operating within a payer landscape that hasn't yet made the move to pay-for-value, this can be a challenge.

My recommendation (and the path that my organization, Grafton Integrated Health Network, has pursued) is to build a strategy for defining your own value by looking at what success means to your organization and the consumers you serve.

First, you need to look at your current market and how major payers for your services are defining value. In many states, Medicaid programs are moving forward with alternative payment models and establishing clear performance metrics with new value-based reimbursement models (see  State-By-State Analysis Of Medicaid MCO Requirements For Provider Alternative Payment Reimbursement). How your state is, or is planning to define value is how your organization should be defining value.

However, in other states, there hasn't yet been a move towards adopting value-based care. In my home state of  Virginia for example, the state Medicaid program hasn't made many moves towards value-based payment models. Grafton is primarily a Medicaid shop, which means that right now, our reimbursements aren't tied to value.

This leads me to my second, long-term recommendation for your organization. You need to start thinking about how to define and demonstrate value on your own.  Read more here.
Rural Colorado's Opioid Connections Might Hold Clues To Better Treatment

A doctor handed Melissa Morris her first opioid prescription when she was 20 years old. She'd had a cesarean section to deliver her daughter and was sent home with Percocet to relieve post-surgical pain. On an empty stomach, she took one pill and lay down on her bed.   "I remember thinking to myself, 'Oh, my God. Is this legal? How can this feel so good?' " Morris recalls.

Soon, she started taking the pills recreationally. She shopped around for doctors who would write new prescriptions, frequenting urgent care clinics where doctors didn't ask a lot of questions and were loose with their prescription pad.

Morris's path started with Percocet and Vicodin, commonly prescribed pain medications for acute injuries and illnesses. When those drugs no longer got her high, she switched to Oxycontin pills. Then she started injecting Oxycontin. After that, she got her hands on Fentanyl patches, a highly addictive and potent opioid. She'd chew on them instead of applying them to skin as the package directed.

When doctors got wise to Morris' shopping tactics, her supplies of the pills diminished, and she turned to heroin, instead.

She started stealing to fund her addiction. Morris then got into the drug trade herself, dealing methamphetamine and other illicit substances, to raise money to buy more heroin.

"You can buy a gram of heroin for 50 bucks," she says. It's relatively cheap. "That's why so many people here have turned to heroin." 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.