The Coalition is excited to join with community leaders and behavioral health professionals as we honor individuals who have shown a strong commitment to improving the lives of people living with behavioral health disorders, as well as strong service to the behavioral health community.
This year we will be honoring these four individuals during the 2016 Leadership Awards:
By Bradley Jacobs
In April, I attended yet another funeral of a person with a serious mental illness. He was 47 years old (two years older than me) and died as a result of a cardiovascular disorder. The experience was simultaneously heartbreaking, hopeful and moving. I was able to take some comfort in the fact that he had family around to reflect on and celebrate his shortened life. After the service, which I attended with a friend, we concluded that we had attended too many funerals in our careers as social workers in the behavioral health field. We felt that he should not have died from a health condition that generally causes death in people 30 years older. Nevertheless, it is all too common amongst people with serious mental illness.
Most people with serious mental illness die from "natural causes" such as cardiovascular disease, pulmonary disease, and infectious disease at higher rates than deaths from suicide or accidents (Walker, 2015), anywhere from 10 - 30 years earlier than people without a mental illness (Walker; Bartels; Insel, 2015). The contributing factors to these health conditions are broad and complex issues themselves: poverty; tobacco and substance use; diet; lack of exercise; incarceration; and the side effects of antipsychotic medications (Bartels; Insel, 2015).
A recent review and meta-analysis of mortality studies by Walker, McGee, and Druss that specifically looked at the rate and cause of early mortality that could be attributed to mental illness found “that 14.3% of deaths worldwide, or approximately 8 million deaths each year, are attributable to mental disorders (Walker, 2015).” Dr. Thomas Insel notes that another way to look at this finding is that “8 million deaths could be averted if people with mental illness were to die at the same rate as the general population (Insel, 2015)."
It is hard to look at all the data regarding the significant physical health problems of people with serious mental illness and not think that we have neglected to do all we can to help address these health disparities. Our personal attitudes about mental illness and a fragmented health care system pose challenges to a whole health approach. However, all this is slowly changing.
Many Coalition member agencies and community partners are engaged in pilot programs to help address some of the medical problems facing recipients of behavioral health care services. Community Access has developed a Health Division to help guide the agency’s approach and has established some early pilot programs that include urban agriculture and a bike share program for supportive housing tenants. The BASICS Esperanza Personalized Recovery Oriented Services (PROS) Program at Acacia Network, through a SAMHSA Primary Behavioral Health Care Integration (PBHCI) program grant, is co-located with a primary care clinic where practitioners from both programs meet frequently with participants to review mental health and physical health care objectives. A major focus in the first year of the grant has been on weight loss strategies and PROS participants are showing some positive results. The CBC Health Home Program in collaboration with Postgraduate Center for Mental Health and EmblemHealth have developed a pilot project to look at the health care gaps of participants receiving care management services through the Health Home, and to help guide the care managers’ interventions to close those identified gaps. Many program models integrate nursing into behavioral health programs and psychosocial rehabilitation programs are also well positioned to advance the teaching of skills and knowledge to help individuals support their own health and wellness.
In New York State, the “carving in” of behavioral health into Medicaid managed care through Health and Recovery Plans (HARPs) and Delivery System Reform Incentive Payment (DSRIP) Program highlight the importance of integrated health care. And interventions that address the social determinants of health will be central to Value Based Payment arrangements. The SAMHSA-HRSA Center for Integrated Health Solutions (http://www.integration.samhsa.gov/) is also helping us move in the right direction, by developing resources, tools and the beginnings of an evidence base in health promotion programs for people with serious mental illness and substance use disorders.
My hope is that we can continue to build on these changes and more urgently address our overall health in addition to behavioral health. So, I reflect on this man's life and realize that I likely have another 30 years to be a part of helping to figure out how to prevent others like him from dying too soon. All the people that worked with him over the last several years, especially his family, did what they could to encourage him, but he had other interests that he generally put ahead of his health. In addition, getting him to primary and specialty care providers was always a challenge. It was a challenge because of my own bias; I was often more focused on his mental health issues than on his physical health. But it was also a challenge because the clinics were too far away and he never felt welcome and comfortable at health care clinic sites. So I wonder had we had services that could have wrapped both his mental health and physical health care in one place would he have lived a few more years? I have hope as I think that new practitioners learn and grow in environments that are tackling a person’s entire health and look forward to a time when weddings, graduations, and other happy social events, rather than funerals are what we get to witness.
By Jamin R. Sewell
On July 8, 2016, the Senate voted 92-2 and on July 13, 2016, the House of Representatives voted 407-5 to support the Conference Report on the Comprehensive Addiction and Recovery Act of 2016 (CARA) (S.524) bringing the legislation one step closer to enactment. A conference report is the product of the House and Senate’s effort to resolve differences between two versions of similar legislation. The “conference” is the meeting between committees appointed by the leadership of each chamber. The bill will now be sent to President Obama for his approval.
In our May edition Briefs, Cheryl Bobe, our Senior Associate for Substance Use Services, summarized the common provisions in the two versions of CARA.
Coalition members and staff advocated for this passage of CARA through in-person meetings on Hill Day, letters and emails.
While The Coalition is disappointed the conference report does not contain additional funding for the bill's many provisions, we will continue working to make sure funding is appropriated for lifesaving prevention, treatment, and recovery support services.
According to the National Council for Behavioral Health, “This bill is the result of many years of tireless advocacy and represents an important, bipartisan step forward in efforts to address the nation's opioid use and abuse epidemic. The final report prioritizes prevention, treatment and recovery support services for those living with and in recovery from addiction. It also makes available overdose reversal medications and trainings as well as law enforcement and criminal justice education.”
By Jamin R. Sewell
On July 6, the House passed the Helping Families in Mental Health Crisis Act (H.R. 2646) by 422-2.
The bill - originally introduced three years ago by Reps. Tim Murphy (R-Pa.) and Eddie Bernice Johnson (D-Texas) in the aftermath of the 2012 Newtown tragedy reflected the frustration of many who know we can and should do better when it comes to people with serious mental illnesses.
Helping Families in Mental Health Crisis Act has the following provisions:
The bill has undergone substantial revisions in attempt to balance the privacy rights of consumers/clients and the desire of families to have more tools to bring their loved ones to treatment.
While not perfect, the legislation is a positive step in the right direction for the behavioral health sector and the people we serve. In order to confront the primary barrier to care– insufficient treatment capacity—the Senate needs to include elements of The Excellence in Mental Health Act and the Mental Health First Aid Act as it considers the Helping Families in Mental Health Crisis Act.
The Coalition joins the National Council in its conclusion that the Helping Families in Mental Health Crisis is important progress and joins the call for more comprehensive behavioral health access.
By Pamela Tindall-O’Brien, Esq.
Starting December 1, 2016, in New York City, children and adolescents eligible for Health Home services will begin enrollment. Children who receive Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services will not be enrolled until a later date, yet to be determined.
CMS, in April 2016, approved the State Plan Amendment (SPA) allowing the State’s Children’s Health Home plan to forward. The SPA authorizes the use of the Child and Adolescent Needs and Strengths - NY (CANS-NY) assessment to determine Health Home Per Member Per Month Rates (PMPM) as well as outreach and assessment Rates. Rates are being set on a preliminary basis for the period December 1, 2016 to November 30, 2018 to provide an opportunity to review the adequacy of the rates.
In order to enroll in a health home, a child must be Medicaid-eligible and have two or more chronic conditions (e.g., Substance Use Disorder, Asthma, Diabetes), or one single qualifying chronic condition, defined as HIV/AIDS, Serious Emotional Disturbance (SED) or Complex Trauma.
Chronic condition criteria is not population specific (e.g., being in foster care, under 21, in juvenile justice, etc. does not alone automatically make a child eligible for Health Home services). In addition, the child or adolescent must be appropriate for the intensive level of care management services provided by Health Home, i.e., satisfy appropriateness criteria.
The referrals for children who are not in foster care will be documented by the Health Home Care Manager through the gathering of supporting information which must include a diagnosis from the DSM “Qualifying Mental Health Categories” made by a licensed practitioner who can diagnose and a report from a licensed practitioner (clinicians, pediatricians, school social workers, etc.) that the child meets the SED functional limitations requirements.
For children in foster care, the process and timelines are somewhat different. Since foster care children will not enter Medicaid Managed Care until July 2017 in New York City, they can be enrolled in Health Homes as of December 1, 2016, but on a fee-for-service basis—bills for other children’s health home enrollees, in New York City, will be handled through managed care organizations.
When a child meets Health Home eligibility and appropriateness, the Voluntary Foster Care Agency (VFCA) (in NYC, the Administration for Children’s Services) serving this child would become the Health Home Care Management Agency.
In the rest of the State, the Local Department of Social Services (LDSS) Commissioner, will refer the child for Health Home serves via the Medicaid Analytics Performance Portal (MAPP). The LDSS Case Managers, VFCA Case Planners, and Health Home Care Managers will function as a team to develop mutual goals.
A referral cannot be made without consent from the member if the member can self-consent, or a parent/guardian/legally authorized representative.
For billing rules providers should go to the following website to review the billing webinar recently held: Click here.
DSRIP Timeline for Year Two Updated
The MRT has updated the DSRIP Year Two Timeline to reflect recent changes to key DSRIP deliverables. The updates include the opening of Medicaid Analytics Performance Portal (MAPP) in August for PPS to add providers to their Performance Networks as well as the announcement to PPS Leads informing them of the opportunity to submit additional Regulatory Waiver Request applications by August 1. Other additions to the timeline include PPS submission of Primary Care Project Narrative by August 31 and several deliverables around Mid-Point Assessment recommendation public comment periods and Project Approval & Oversight Panel review.
The DSRIP Year Two Timeline is available at:
Questions related to the timelines can be directed to DSRIP@health.ny.gov.
NYS Releases Updates to CFR Rules
New York State has updated the State’s Consolidated Fiscal Reporting and Claiming (CFR) requirements, timeframes, processes and forms. This pertains to billing/reporting Medicaid claims through OMH, OASAS and OPWDD. A summary of the updates and links to the CFR manuals can be found here.
Go Live Date of Children’s Health Homes Pushed to 12/1/16 and Rates for Health Homes Amended
Effective December 1, 2016, the NYS Department of Health will include the Health Home payments for both children and adults in the MCO capitation rates. MCO capitation rates (Mainstream, HARP and HIV/SNP) will be adjusted to include estimated HH Per Member Per Month (PMPM) payments in the July 1, 2016 rate package for the period December 1, 2016 through March 31, 2017 plus up to one additional month of payments, five months in total.
It is our hope that this change in billing procedures will expedite payment to Health Homes and facilitate better cash flow for downstream service providers.
The letter from DOH announcing the amendments can be found here.
DOH to Submit Amended HCBS Transition Plan to CMS; Public Comments Due August 19, 2016
The Department of Health (DOH) is submitting an amended Home and Community-Based Services (HCBS) Statewide Transition Plan (STP) as required by the Centers for Medicare and Medicaid Services’ (CMS) HCBS Final Rule.
To read the full plan, please go to: https://www.health.ny.gov/health_care/medicaid/redesign/home_community_based_settings.htm
This document follows DOH’s initial STP and provides more specificity about both systemic and site compliance with the requirements of the rule, details its assessment process and remediation plans, and identifies categories of sites that will require heightened scrutiny.
We strongly encourage our members to comment. The deadline for comments is August 19, 2016 by close of business. Please email comments to HCBSrule@health.ny.gov. If you would like The Coalition to include your comments with its submission, please email your comments by August 7, 2016 to firstname.lastname@example.org.
New Report on Value Based Payment Models for Medicaid Child Health Services
On July 13, 2016, the United Hospital Fund and Schuyler Center for Analysis and Advocacy released report titled, “Value-Based Payment Models for Medicaid Child Health Services.”
The report is a must-read for children’s behavioral health and physical health providers and for providers interested in expanding to children’s services.
It concludes that substantial differences in children’s health care utilization compared to adults and in “the value of children’s health care argues for a different approach to value-based payment. They suggest that the payment model should promote—and pay for—screening and effective interventions to address psychosocial risks that are not currently widespread in primary care.
The authors also suggest that payment models take into account socioeconomic risk and consider approaches that address parental health and well-being.
Another recommendation is developing separate payment strategies for very high-need children, whose service needs generate high costs and are generally addressed by specialists. Finally, the report notes that improving value for children is unlikely to generate short-term savings, and in fact may require an upward adjustment in capitated payments for primary care.”
The Coalition welcomes this valuable analysis into the value based payments discussion.
Coalition Member-Only Events
Substance Use Committee Meeting
Around the Water Cooler
Acacia Network has youth residential bed available at a long-term 24-hour all-inclusive residential program for youth with substance use and mental health issues. In addition, they provide educational services through the Department of Education as well as full medical, vocational, recreational and psychiatric services. To make a referral you can contact Tanya Caba (Court Liaison) at (718)530-4572, Vernika Curry (Social Worker) at (718)960-7504, or Audrey Hyde (Program Director) at (718)764-1556.
At a recent ribbon cutting ceremony in the Tremont neighborhood of the Bronx, CUCS celebrated the opening of a new supportive residence, The Sydelle. The 107-unit is LEED Silver environmentally certified, features a gym and computer lab and on-site services include crisis prevention and intervention, entitlement and legal assistance, household management and coaching, employment assistance, and primary medical care and psychiatric services.
In a press release of June 29, 2016, The Children’s Aid Society announced the hiring of Sarah Gillman as chief financial officer and Sandra Escamilla-Davies as vice president for the Adolescence Division. Gillman will oversee all of the agency's financial matters, including the annual operating budget, payroll, purchasing and the endowment, among other areas. Escamilla-Davies will lead an array of programs designed to help young adults prepare for college, career, and a successful, independent life. Both start with the organization on July 6.
In a press release of June 30, 2016, Senators Charles Schumer & Christine Gillibrand announced that GMHC, would receive $1,283,497 in federal funding which will provide victims of domestic violence housing placement assistance, short-term rental assistance and short term rent, mortgage and utility assistance.
The Institute for Community Living’s collaboration with Community Healthcare Network and the Primary Care Development Corporation to build a comprehensive service delivery Hub in Brooklyn, which we covered in our last edition of Briefs, was mentioned in July 19, 2016 edition of Crain’s Health Pulse.
Jeremy Christopher Kohomban, Ph.D., CEO of The Children’s Village, authored an article in the Huffington Post regarding H.R. 5456, the Family First Prevention Services Act of 2016, which allocates federal resources for preventive and family support services while establishing a national standard for residential treatment, which was recently passed in the House of Representatives.
Union Settlement’s hiring of Susan Pruder as Director of Development and Communication and Joy Pittman as the Director of Human Resource was mentioned in DNAinfo on July 11.
SAGE’s role in developing two new affordable LGBT senior-friendly housing complexes in the Crotona section of the Bronx and Fort Greene, Brooklyn was detailed in The Wall Street Journal, Real Estate Weekly, Gay City News and other publications.
VIP Community Services is pleased to announce that they can now offer free CASAC training to employees of organizations that are part of the Bronx Lebanon PPS. Applicationsare due by 7/22/16 and should be sent to Deborah Witham at email@example.com with a copy to firstname.lastname@example.org.
Elizabeth Swain, President & CEO of advocacy partner CHCANYS, for eleven years, passed away on July 7, 2016.
In the words of Beverly Grossman, her colleague at CHCANYS, “During Elizabeth’s 11 years as President and CEO, CHCANYS grew from a small advocacy organization with five employees into one of the nation’s leading primary care associations, supporting over 65 Federally Qualified Health Centers (FQHC), the primary health care provider for nearly two million New Yorkers.
Elizabeth was a tireless advocate for the community health center movement and the people it serves, spending nearly her entire career working to support and expand access to primary care services in medically underserved communities.
CHCANYS, New York’s health centers, their patients and the greater health advocacy community are deeply grateful to Elizabeth for her many years of thoughtful and inspired leadership; she will be greatly missed.” We will miss her, too.