Advancing Public Policies for People with Mental Illness, Chemical Dependency or Developmental Disabilities
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New Report Reveals Worsening Disparities in Access to Behavioral Healthcare for Employer-Sponsored Health Plans
Disparities between physical and behavioral healthcare for both in-network access and provider reimbursement rates are making it even harder for American families to find affordable and available mental healthcare and addiction treatment according to a new study. The report, published by Milliman, Inc. covering 37 million employees and dependents, and commissioned by The Bowman Family Foundation, reflects that conditions have worsened since a similar study was published two years ago.
The report, "
Addiction and Mental Health vs. Physical Health: Widening disparities in network use and provider reimbursement," shows the gap in disparities for employees and their families seeking mental health and addiction treatment versus treatment for physical health conditions widened in 2016 and 2017. The study, based on actual claim data in all 50 states for hundreds of health insurance plans, demonstrates that "out-of-network" use of behavioral providers is higher than out-of-network use of medical and surgical providers - and the degree of disparity has grown substantially in recent years, despite state and federal efforts to promote parity. The study also documented much lower reimbursement rates paid by insurers to behavioral providers for "in-network" services, with the gap between behavioral versus medical/surgical providers widening.
"The study's findings are beyond disappointing and disturbing," said Henry Harbin, MD, a psychiatrist, former CEO of Magellan Health Services, and advisor to The Bowman Family Foundation. "With the extensive efforts by multiple stakeholders, over the last several years, we were expecting to see significant improvements. Instead, we are going backwards." Read more
here.
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"In Case You Missed It" - CLMHD
Recaps Key Information Issued by the State
The Conference has published the October edition of "In Case You Missed It (ICYMI)," a one-stop-shop highlighting key information released by our state partners. ICYMI provides a clear, concise recap of significant state guidance, regulations, and resources from OMH, DOH, OASAS, and OPWDD, as well as links to access documents and materials of importance.
Click
here to read the October issue.
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2020 Updates to the Adult and Child Core Health Care Quality Measurement Sets
On Tuesday, the Centers for Medicare & Medicaid Services (CMS) released an Informational Bulletin that describes the 2020 updates to the core set of children's health care quality measures (the Child Core Set) for Medicaid and the Children's Health Insurance Program (CHIP) and the core set of health care quality measures for adults enrolled in Medicaid (the Adult Core Set).
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The Health Care System Isn't Ready to Replace Aging Caregivers
The first generation of developmentally disabled adults who grew up at home, not in an institution, are now middle-aged and facing a health care system that's largely unprepared to take care of them as their baby boomer parents age out of that role.
Numbering in the tens of thousands, they were the test case for deinstitutionalization. Now they are test cases for an ill-defined, underfinanced future. Most have never spent much time away from their parents and are on long waitlists for state services, which may be out of reach until an emergency strikes.
State lawmakers are aware of the problem; some have spent money to try and address it. But with whispers of a possible recession on the horizon, and with more boomers entering their 70s every day, many families and advocates fear what will befall this already fragile population. Read more
here.
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UPCOMING EVENTS &
TRAININGS
Using PSYCKES Recipient Search
December 3, 3 - 4 pm, OMH
Overview of Evidence-based Tools and Approaches Across the Sequential Intercept Model (SIM)
December 4, 12:30 - 2 pm, SAMHSA's GAINS Center
What Addiction Professionals Should Know About Medical Marijuana
December 4, 3 - 5 pm, NAADAC
Using Data to Identify and Serve People who Frequently Utilize Health, Human Services and Justice Systems
December 5, 2 - 3:15 pm, NACo
Leveraging Telehealth for Justice-Involved Individuals: Expanding Access to Mental and Substance Use Disorder Treatment
December 11, 1 - 2:30 pm, SAMHSA's GAINS Center
Using PSYCKES Quality Indicator Reports
December 12, 2 - 3 pm, OMH
Making Health Care Transition Work for Youth with Autism: Youth and Parent Perspectives and National Resources
December 13, 2 - 3 pm, National Institute of Mental Health
PSYCKES Mobile App for iPhones & iPads
December 18, 10 - 11 am, OMH
Health Plan Innovations in Population Health Management for Complex Consumers
December 18, 12 - 1 pm, PsychU
Successful Treatment of Methamphetamine Addiction
December 18, 3 - 4:30 pm, NAADAC
Using PSYCKES for Clinicians
December 19, 2:30 - 4 pm, OMH
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Office Closed - Thanksgiving
November 28 - 29
DECEMBER 2019
Executive Committee Call
December 4: 8 am, GTM
Children & Families Committee Meeting
December 17: 11:30 am - 1 pm, GTM
Office Closed - Christmas
December 25
Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422
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Malone-Based Agency Will Take Over Glens Falls Hospital's Outpatient Mental Health Programs
A mental health agency from Malone will take over all of the outpatient behavioral health and addiction services provided by Glens Falls Hospital next spring.
The announcement came as a great relief to Rob York, director of community services for Warren and Washington counties.
It's his job to ensure that the counties provide mental health care and substance abuse treatment. That job became a lot more difficult this summer, when hospital officials told him they were getting out of the outpatient behavior health field.
He needed to find new providers for 2,200 patients - adults, children and those struggling with substance abuse. Read more
here.
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Ellenville Hospital at Forefront of New Approach to Treating Deadly Substance Abuse
There's a concept in the world of substance abuse treatment that says there should be no wrong door to get help.
As the opioid epidemic has unspooled, claiming victim after victim and heedless of demographics or economic background, the people in the trenches have come up with another, complementary approach: Meet them where they're at.
It's an evolution in the approach to treatment, patient-centered, evidence-based, empathetic and practical. The approach recognizes that while opioid use disorder is a potentially lethal affliction, the person has to be ready to seek treatment. And when they're ready, they need support: medication to get them through withdrawal and cravings, counseling to address their underlying trauma or mental health issues, and someone to help them with insurance and placement into treatment.
According to the Centers for Disease Control and Prevention, between 1999 and 2017, opioid overdoses killed 218,000 people, 47,000 just in 2017. The rise has been driven in waves, the CDC says: In the late 1990s through the early 2000s, deaths due to prescription opioids, including methadone prescribed for pain, began to rise. In 2010, deaths due to heroin overdose began to surge. In 2013, the overdose death curve steepened dramatically as synthetic opioids, primarily fentanyl and its chemical analogs, entered the street drug market as an additive to or substitute for heroin.
The problem is particularly alarming in the mid-Hudson. Read more
here.
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A New Bill Would Let Doctors Prescribe Addiction Treatments Without Waiting for Insurers' Permission
WASHINGTON -
Fewer doctors would have to wait for permission to prescribe addiction treatment drugs under new, bipartisan legislation being unveiled this week by two lawmakers on the House Energy and Commerce Committee.
Under a new bill authored by Reps. Paul Tonko (D-N.Y.) and David McKinley (R-W.Va.), the practice of "prior authorization," in which insurers require doctors to seek approval before they can proceed with a prescription or procedure, would be banned in state Medicaid programs for addiction treatment medicines like buprenorphine.
The bill comes amid part of a broader movement to expand addiction treatment as the overdose crisis continues to claim roughly 70,000 American lives each year. Experts universally view increasing availability for addiction medicines as critical to preventing future deaths. Read more
here.
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OMH Releases RFP: Capital Awards for Crisis Residential Programs for Children and Adults
The Office of Mental Health announces the availability of capital funds for the acquisition of new property, construction of new facilities and/or the rehabilitation of existing buildings for purposes of developing licensed Residential Crisis Support, Intensive Crisis Residence and/or Children's Crisis Residence programs in accordance with 14 NYCRR Part 589.
Click
here to access the RFP.
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Governor Cuomo Announces $30 Million in Awards for 1,200 Supportive Housing Units Across New York State
Governor Andrew M. Cuomo on Monday announced
163 conditional awards totaling $30 million to agencies in 43 counties across New York to provide support services and operating funding for at least 1,200 units of supportive housing for homeless persons with special needs, conditions or other challenges. This is the fourth funding round of the Governor's Empire State Supportive Housing Initiative. Announced in 2016, ESSHI is one component of the Governor's historic $20 billion, five-year plan to create or preserve more than 100,000 affordable and at least 6,000 supportive housing units.
The conditional awards are for service and operating funding needed to operate permanent supportive housing units. The awards will allow applicants to secure separate capital funding to finance the development and construction of their housing project. Read more
here.
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New York Health Information Exchange Saves $160 to $195M
The New York Health Collaborative (NYeC)
announced a savings of $160 to $195 million annually on healthcare spending due to the use of the Statewide Health Information Network for New York (SHIN-NY), the state's health information exchange.
"Numerous studies have already shown the improvement in health care and reduction in unnecessary healthcare spending that can result from the wide and meaningful use of health information exchange," said Valerie Grey, executive director of NYeC. "This statewide estimate for New York gives us a sense of the magnitude of the current impact and what tomorrow could bring as the SHIN-NY continues to grow and evolve."
An estimated $1 billion could be saved each year if current participants used the NYeC's full capabilities. These cost savings are associated with duplicate testing, avoidable hospitalizations and readmissions, and preventable emergency department visits. Read more
here.
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Governor Cuomo Announces $56.5 Million for Supportive Housing for Homeless Individuals and Families Across the State
Governor Andrew M. Cuomo on Tuesday announced that $56.5 million in state funding has been awarded to 15 projects that will provide housing for homeless individuals and families. The projects, funded through the New York State Office of Temporary and Disability Assistance's Homeless Housing and Assistance Program, will create nearly 600 units of permanent supportive housing and 40 emergency shelter beds for veterans, survivors of domestic violence and individuals with mental illness.
The program is still accepting applications for $7.5 million in funding available for projects in New York City and its suburbs - Westchester, Nassau and Suffolk counties - and for emergency shelter repairs. Read more
here.
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SAMHSA's GAINS Center Invites Communities to Apply for Sequential Intercept Model (SIM) Mapping Workshops
SAMHSA's GAINS Center is soliciting applications from communities interested in Sequential Intercept Model (SIM) Mapping Workshops (SIM Workshops). SIM Workshops are designed to bring together a local, cross-system, multi-disciplinary group of key stakeholders from a particular jurisdiction to facilitate collaboration and to identify and discuss ways in which barriers between the criminal justice and behavioral systems can be reduced through the development of integrated local strategic plans. SIM Workshop participants are expected to be drawn, in large part, from local criminal justice and behavioral health agencies and organizations.
SAMHSA's GAINS Center will provide the SIM Workshops free of charge in selected communities between March and August 2020. There are no fees for registration, tuition, or materials associated with these workshops. The GAINS Center will cover all the costs related to pre and post-workshop planning and coordination, facilitator time and travel, data collection and analysis, and report development.
To apply for a SIM Workshop, please click on the opportunity below that is most appropriate for your community and submit a completed application no later than
December 20, 2019.
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In Many Rural Hospitals, the ER Doctor is Online
SIOUX FALLS, S.D. - A flashing red light summoned Dr. Brian Skow to his third emergency of the afternoon, and he hurried to a desk in a suburban office building. He sat in front of an oversize computer monitor, which showed a live video feed from inside a hospital room in eastern Montana. Two nurses were leaning over a patient on a stretcher, checking for a pulse, and squeezing oxygen out of a bag and into the patient's lungs.
"I'm Doctor Skow," he said, waving into a camera attached to his computer, introducing himself as the presiding emergency physician even though he was seated more than 700 miles away. "How can we help you today?"
"We have a female patient, comatose and unresponsive," one of nurses in Montana said. The nurse was short of breath, and she looked up at the camera mounted to the wall of the exam room as she attached monitors to the patient's chest. "She's a known diabetic. Blood sugar over 600. I - I don't really know. I haven't seen a whole lot of this."
"You're doing great," Skow said. "We'll walk through it together. That's why we're here."
As hospitals and physicians continue to disappear from rural America at record rates, here is the latest attempt to fill a widening void: a telemedicine center that provides remote emergency care for 179 hospitals across 30 states. Read more
here.
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Transforming Pilot Models into Sustainable Rural Health Programs
Addressing rural health disparities can be challenging as these communities often have sparse resources and limited access to healthcare services. To combat this problem, many small, local grants fund projects aimed at addressing diseases that are disproportionally burdensome to rural communities.
The challenge many project leaders face is sustaining their program after initial grant funding has expired. Some programs are unable to maintain their work, leaving the beneficiaries of these programs without the resources to continue promoting better health.
Four programs were explored that are breaking this cycle by integrating sustainability into project development. While all four programs tackle different health issues across the country, common themes articulate best practices in rural areas. Read more
here.
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