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March 30, 2016

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

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Francine Sinkoff, Editor

Apply Now: Justice and Mental Health Collaboration Program

The U.S. Department of Justice's Bureau of Justice Assistance (BJA) is seeking applications for the Justice and Mental Health Collaboration Program (JMHCP), which supports innovative cross-system collaboration for individuals with mental illnesses or co-occurring mental health and substance use disorders who come into contact with the justice system.

JMHCP seeks to increase public safety by facilitating collaboration among the criminal justice and mental health and substance abuse treatment systems to increase access to mental health and other treatment services for individuals with mental illnesses or co-occurring mental health and substance abuse disorders. The program encourages early intervention for these multisystem-involved individuals; maximizes diversion opportunities for multisystem-involved individuals with mental illnesses or co-occurring mental and substance abuse disorders; promotes cross-training for justice and treatment professionals; and facilitates communication, collaboration, and the delivery of support services among justice professionals, treatment and related service providers, and governmental partners.

Eligible applicants are limited to states, units of local government, federally recognized Indian tribes (as determined by the Secretary of the Interior), and tribal organizations. BJA will only accept applications that demonstrate that the proposed project will be administered jointly by an agency with responsibility for criminal or juvenile justice activities and a mental health agency.

Applications are due May 17. Click here to learn more and apply.
HHS Releases Guidance for Syringe Services Programs

This morning, HHS issued guidance regarding the use of Federal funds to implement or expand syringe services programs for people who inject drugs. An overview of the guidance and a link to the complete document can be found here.     
The release of the HHS guidance was part of a broader set of public and private sector actions to escalate the fight against the prescription opioid abuse and heroin epidemic, which is claiming the lives of tens of thousands of Americans each year. Click here for a link to the full White House announcement:
Additional information and guidance for HHS grantees will be coming out over the next two weeks from the relevant HHS agencies.
Justice Center Self-Assessment Tool for an Abuse Free Environment

The New York State Office of Mental Health (OMH) has partnered with the Justice Center for the Protection of People with Special Needs in the development of an optional tool for providers under the jurisdiction of the New York State Protection of People with Special Needs Act. The tool is the Self-Assessment for an Abuse Free Environment. It is a voluntary tool that providers can use to evaluate their programs for risk of quality management vulnerabilities and to provide resources to mitigate identified risk areas.  
OPWDD Response to Public Comment Period for the 1915 (c) HCBS Waiver Renewal Application

OPWDD received comments from over 90 individuals or organizations on important topics including access to services, individual rights, changes to existing services and proposals for the addition of new services.

Click here to read the response that is located on the OPWDD website.  Based on the comments received, and after consultation with CMS, OPWDD will submit the waiver application without technical changes to Respite funding and other fiscal changes.   The Waiver Renewal includes language which commits OPWDD to submit an additional amendment later in 2016 to effect the fiscal changes and to begin to implement reforms stemming from the work of the Commissioner's Transformation Panel. 

Report:   Reducing Mental Illness in Rural Jails

The Stepping Up Initiative: Reducing Mental Illness in Rural Jails, developed as part of the larger Stepping Up Initiative and endorsed by NARMH and the National Sheriff's Association, describes special challenges rural counties and communities face when insufficient behavioral health services lead the justice system to substitute correctional facilities for community behavioral health services. It provides rural county leaders with strategies to address these challenges, providing examples of counties that have successfully done so or are making progress.  Click here to download this important report.
FDA Requires 'Black Box' Warning on Painkillers

In an attempt to help slow the prescription drug abuse epidemic, the U.S. Food and Drug Administration announced Tuesday that immediate-release opioid painkillers such as oxycodone and fentanyl will now have to carry a "black box" warning about the risk of abuse, addiction, overdose and 
Prescription opioid painkillers are divided into two main classes -- extended release, which have more pain-killing opioid per dosage, and immediate release, which have less opioids, but need to be taken more frequently. Ninety percent of opioid prescriptions are for immediate-release painkillers, the FDA said.

The "black box" warnings are the FDA's strongest, and they're meant to educate doctors as they're prescribing medications to patients.   Here's how the warning will play out for consumers, according to the FDA.   When a patient gets his or her prescription filled, the bottle should have a notification indicating there is a black-box warning for the drug. The consumer would need to go to the manufacturer's website for details.

In addition, pharmacists are encouraged to provide patients with a medication guide -- consumer-friendly language explaining the risks of the drug. Under this new effort from the FDA, all instant-release drugs will need to have such a guide. It is up to the pharmacist to dispense this information, something the FDA encourages.  Read more here.
Probing The Complexities Of Transgender Mental Health

Experiencing the world as a different gender than the one assigned you at birth can take a toll. Nearly all research into transgender individuals' mental health shows poorer outcomes. A new study looking specifically at transgender women, predominantly women of color, only further confirms that reality.

What's less clear, however, is whether trans individuals experience more mental distress due to external factors, such as discrimination and lack of support, or internal factors, such as gender dysphoria, the tension resulting from having a gender identity that differs from the sex one was assigned at birth.

Transgender people are often treated extremely poorly by their parents, by their schools, by society at large, and that can leading to problems in school and at work, as well as poverty and increased risk of substance use, according to Ilana Sherer, assistant medical director of the Child and Adolescent Gender Center at the University of California Benioff Children's Hospital in San Francisco.

The study published Monday in JAMA Pediatrics reveals the difficulty in picking apart this question. It examined mental health and substance use among nearly 300 young transgender women in Chicago and Boston.  Read more here.


March 31, 1:30 - 2:30 pm,  National Council for Behavioral Health

Implementing Recovery-oriented Practices: Assessing strengths and priorities
April 5, 12:30 - 1:30 pm, SAMHSA-HRSA
April 6, 2 - 3:30 pm, SAMHSA

April 6, 3:30 - 5 pm,  CMS & Truven Health

April 14, 2 - 3:30 pm, SAMHSA

April 19, 2 - 3:30 pm, Core Solutions, Inc.


APRIL 2016
Officers & Chairs - Call In
April 6:  8 am

Mental Hygiene Planning 
April 7:  11 am - 1 pm
GTM Only

Director's Meeting 
April 19:  10 am - 12 pm
GTM Only

Children & Families Committee
April 19:  12:30 - 1:30 pm
GTM Only

MAY 2016
Spring Full Membership Meeting & CLMHD 40th Anniversary Dinner
May 2 - 3: The Desmond, Albany

Officers & Chairs - Call In
May 4:  8 am

Mental Hygiene Planning 
May 5:  11 am - 1 pm
GTM Only

Children & Families Committee
May 17:  11:30 am - 1 pm
GTM Only

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

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

Developmental Disabilities Committee
May 25:  11 am - 12 pm
GTM Only

CLMHD Mentoring Workshop
May 25:  10 am - 4 pm
DoubleTree by Hilton Hotel, Syracuse

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
CMS finalizes mental health and substance use disorder parity rule for Medicaid and CHIP

In conjunction with the President's visit to the National Rx Drug Abuse and Heroin Summit, the Centers for Medicare & Medicaid Services (CMS) yesterday finalized a rule to strengthen access to mental health and substance use services for people with Medicaid or Children's Health Insurance Program (CHIP) coverage, aligning with protections already required of private health plans. The Mental Health Parity and Addiction Equity Act of 2008 generally requires that health insurance plans treat mental health and substance use disorder benefits on equal footing as medical and surgical benefits.

The protections set forth in this final rule will benefit the over 23 million people enrolled in Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and CHIP.  Currently, states have flexibility to provide services through a managed care delivery mechanism using entities other than Medicaid managed care organizations, such as prepaid inpatient health plans or prepaid ambulatory health plans. The final rule maintains state flexibility in this area while guaranteeing that Medicaid enrollees are able to access these important mental health and substance use services in the same manner as medical benefits.   

Under the final rule, plans must disclose information on mental health and substance use disorder benefits upon request, including the criteria for determinations of medical necessity. The final rule also requires the state to disclose the reason for any denial of reimbursement or payment for services with respect to mental health and substance use disorder benefits.  Read more here.
White House to Commit $116m to Heroin and Opioid Abuse Epidemic

The  Obama administration announced new measures on Tuesday to combat the growing epidemic of heroin and prescription opioid abuse, most of which are centered on prevention and treatment, not crime-fighting.

The White House is committing $116m to support treatment, with nine actions that include expanding access to care and drugs for combatting overdoses. It also proposed $7m in US justice department funding to increase community policing.

Michael Collins, deputy director for national affairs at the  Drug Policy Alliance, said the increased focus on helping addicts rather than interdicting drugs and incarcerating dealers continues Obama's commitment to "doing more than previous administrations to roll back the war on drugs".   But Collins questioned where the funds would come from to pay for the proposed measures, and called the policing proposal a "step backward".

Tuesday's announcement builds on Obama's call last month for an additional $1.1bn in congressional funding to fight the growing public health problem, according to the White House. Opioids have killed 28,647 people in 2014, a four-fold increase in opioid overdoses since 2000,  according to the Centers for Disease Control and Prevention.
Obama is expected to discuss the plan Tuesday afternoon on a panel at the National Prescription Drug Abuse Heroin Summit in Atlanta.

The most significant monetary investment in the plan is $94m in "new funding" that Health and Human Services Department (HHS) released earlier this month, so that 271 Community Health Centers could expand "medication-assisted treatment of opioid use disorders in underserved communities". This funding could result in the centers treating 124,000 new patients, according to the White House.

The plan also includes $11m for states to distribute naloxone, a drug that reverses opioid overdoses, and an HHS proposed rule that would allow qualified doctors to increase the number of patients to whom they can prescribe buprenorphine, a drug that combats opioid addiction, from 100 to 200.  Read more here.
New York Begins Readiness Reviews For Integrated Medicaid Medical/Behavioral Managed Care Plans Outside New York City

Medicaid Managed Care plans available by county online - click here.

During March 2016, the New York State Office of Mental Health (OMH) is starting on-site readiness reviews for Medicaid managed care organizations (MCOs) that will provide integrated medical and specialty behavioral health services to Medicaid beneficiaries living outside the New York City (NYC) area. The state is in the process of ending its Medicaid behavioral health carve out for specialty services. The integrated plans went live in New York City in January 2016. The MCOs are slated to begin providing services outside the NYC area on July 1, 2016.
As part of the move to integrate behavioral health, all Medicaid mainstream managed care plans (MMC) in the state have had to demonstrate capacity to provide behavioral health services, either on their own, or by partnering with a behavioral health organization (BHO). The MMC plans could also apply to establish specialized Health and Recovery Plans (HARP) for their members with serious mental illness (SMI) or addiction disorder. For the plans serving the rest of the state, the OMH accepted applications through September 18, 2015, from designated MCOs serving New York City.
According to a recent notice issued by Health Management Associates (HMA), the plan designations were announced in New York City in the fall of 2015. The current announcement addresses plans that do not operate in the city, as well as plans that had been approved in the city that are seeking approval to operate in non-NYC counties.

Mainstream MCOs are New York's name for health plans that provide services to individuals not requiring long-term services and supports. Currently, Medicaid MCOs do not provide specialty behavioral health services; but the state is working to transition behavioral health services to the MCOs. In order to continue providing Medicaid services, mainstream MCOs were required to prove that they are able to provide all behavioral health services to adults.
HARPs are a Medicaid Special Needs Plan (SNP) operated by New York's Medicaid MCOs. The HARPs have a specialized staff with behavioral health expertise, and the plan provides all covered services available through Medicaid managed care, in addition to an enhanced benefit package that includes BH HCBS for eligible enrollees. HARP eligibility criteria has been determined by the state. HARP eligibles cannot be dual enrolled (receiving both Medicare and Medicaid) or participating in a program with the Office for People With Development Disabilities (OPWDD).
HARPS in New York City began implementing BH HCBS on January 1, 2016, three months after the mainstream Medicaid managed care organizations (MCOs) began covering non-HCBS behavioral health services. In the rest of the state outside New York City, the mainstream Medicaid managed care plans will begin non-HCBS behavioral health services on July 1, 2016. The delay to launch the BH HCBS for the HARP population is intended follow the New York City roll-out and maintain a three month window between the two types of plans.
--Open Minds - March 16, 2016
Heroin Epidemic Is Yielding to a Deadlier Cousin: Fentanyl

When Eddie Frasca was shooting up heroin, he occasionally sought out its more potent, lethal cousin, fentanyl.

"It was like playing Russian roulette, but I didn't care," said Mr. Frasca, 30, a carpenter and barber who said he had been clean for four months. When he heard that someone had overdosed or even died from fentanyl, he would hunt down that batch.

"I'd say to myself, 'I'm going to spend the least amount of money and get the best kind of high I can,' " he said.

Fentanyl, which looks like heroin, is a powerful synthetic painkiller that has been laced into heroin but is increasingly being sold by itself - often without the user's knowledge. It is up to 50 times more powerful than heroin and up to 100 times more potent than morphine. A tiny bit can be fatal.

In some areas in New England, fentanyl is now killing more people than heroin. In New Hampshire, fentanyl alone killed 158 people last year; heroin killed 32. (Fentanyl was a factor in an additional 120 deaths; heroin contributed to an additional 56.)

"It sort of snuck up on us," said Detective Capt. Robert P. Pistone of the Haverhill Police Department in Massachusetts. He said that a jump in deaths in 2014 appeared to be caused by heroin, but that lab tests showed the culprit was fentanyl.

Fentanyl represents the latest wave of a rolling drug epidemic that has been fueled by prescription painkillers, as addicts continue to seek higher highs and cheaper fixes.

"It started out as an opioid epidemic, then heroin, but now it's a fentanyl epidemic," Maura Healey, the attorney general of Massachusetts, said in an interview.

Fentanyl on a patch or in a lozenge has been used since the 1960s in medical settings to treat extreme pain. In recent decades, illicit fentanyl has seeped into the United States from Mexico.  Read more here.
Debate Arises Over HHS Plans For Privacy Rules On Addiction Treatment

What's more harmful to patients being treated for drug or alcohol abuse: risking their health by keeping other medical providers in the dark about their substance abuse treatment? Or risking their jobs, homes and child custody arrangements by allowing potentially damaging treatment details to be electronically shared among an array of medical providers?

Advocates have painted the possible patient outcomes in starkly different terms as they consider the federal government's recently proposed update to guidelines that govern the release of patient records for alcohol and drug abuse treatment.

What everyone can agree on is that protecting the privacy of people who are being treated for substance abuse is critical. If such information becomes public, it may have a devastating effect on their work and family lives. In some cases, it also may set off a cascade of legal repercussions, including arrest, prosecution and jail. The mere threat that treatment details might be disclosed can be enough to deter people from seeking help.

The current privacy gui delines - often referred to as "Part 2" as an abbreviation for "42 CFR Part 2," the section of the code of federal regulations where the rules are published - last got a meaningful update in 1987 . Since that time, electronic medical records have proliferated, and integrated, patient-centered care has become the organizing principle for doctors, hospitals and health systems.

Existing privacy rules are too cumbersome for today's integrated world, say proponents who favor loosening the rules. Under current Part 2 rules, providers can't disclose treatment information unless patients give their consent to release the information to a specific health care provider.
Part 2 "is well intentioned, but it's just not working," said Matt Salo, executive director of the National Association of Medicaid Directors. "These special [treatment] silos are actually hurting people." The federal/state Medicaid program for lower income people is responsible for a significant and growing share of the money spent on substance use disorder treatment, Salo said. Read more here.
UHF Report:  The Impact of Two New Proposed Mergers on New York's Health Insurance Market

Policy changes and pressures of the marketplace have been driving considerable consolidation in the health care industry. Two proposed mergers involving four of the nation's five largest health insurers-Anthem (Empire) and Cigna, and Aetna and Humana-would have different effects in the various states where these companies operate. This Big Picture snapshot report examines the two merger plans based on the New York footprints of the insurers proposing to merge. It explains the review process by federal and state officials that is currently unfolding, and places the proposed mergers in the context of the Affordable Care Act and a changing health care landscape.

The Next Wave is the second in a series of snapshots highlighting issues related to the Affordable Care Act as a complement to UHF's annual Big Picture chartbook on health plan operations. The first snapshot report,  After the Reinsurance Is Gone , looks at the Transitional Reinsurance Program. Links to other reports in the series will be added as they are published.

Click here to read the full report.
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.