Testimony for Public Hearing Senator Phillip Boyle

Heroin & Prescription Drug Epidemic: Connecting Dots to Youth

November 13, 2013

philip-boyleNancy Beckett-Lawless

Seafield Center

7 Seafield Lane,

Westhampton Beach NY 11978

 

Committee: Senate Standing Committee on Alcoholism and Drug Abuse

 

Good Afternoon Senator Boyle and members of the Committee.  My name is Nancy Beckett-Lawless and I am Director of Provider Relations for Seafield Center.  I am Co-chair of the Managed Care Committees for two New York State provider organizations: ASAP – Association of Alcoholism and Substance Abuse Providers and ATPA – Addiction Treatment Providers Association.  I also Chair the Long Island Insurance and Managed Care Committee and am co-founder of the East End Clinical Connection, a group of behavioral health professionals who provide addiction and mental health treatment to residents living on the east end of Long Island.

 

First, I would like to recognize and thank Senator Boyle and his colleagues in the Senate, and the rest of the Legislature, for their support of the Attorney General’s successful initiative in passing a law at the forefront of the prescription drug epidemic, the  I-Stop Legislation, which we have already seen is effective in curbing the over prescribing and misuse of prescription pain medication.  I would also like to acknowledge the role New York State played in achieving Federal Parity by leading the way with the passage of Timothy’s Law in 2006 which preceded the successful passage of The Mental Health Parity and Addiction Equity Act of 2008. New York State always leads the way in assuring quality care is delivered to our most vulnerable citizens, and we thank you for that.

 

I am here today to ask you to step up one more time to help us close an unintended loophole created by Parity, the issue of medical necessity. The actions I suggest will not cost the State of New York any additional money, but could save the lives of countless young people who overdose from opiates when they are turned away from treatment too early …or not admitted to treatment at all…..because they cannot access the treatment benefits of their own insurance policy by not meeting the proprietary “medical necessity criteria” demanded by their Insurance Company or Managed Care Organization. Every Insurance Company has their own criteria and has a fiduciary interest in denying care!

Young people and others are being denied detox and inpatient rehab every day. *Give the example of the young person assessed in Mineola after his first overdose, approved for detox in a hospital for 3 days and then refused  INP, relapsed on the first night out, assessed again in Mineola for INP and again refused. Admitted to IOP on a Friday, overdosed the 3rd time on Sunday evening, died on the 3rd OD and was brought back with paddles only to be denied the 3rd time for not meeting medical necessity. His family sent him to Florida and when he returned he had no benefits left! He was taken off the parents insurance and put on Medicaid and what should have been the “payer of last resort” once again became the payer of “first resort.” Cost shifting due to medical necessity.

 

We need to do 2 things:  First create a definition of medical necessity that meets the needs of the residents of NYS and the State.  2nd We need to enforce the use of our State LOC determinator, LOCTDAR 2.0 or its equal, for all level of care placement by insurance companies doing business in NYS.

 

New York State has designated the Office of Alcoholism and Substance Abuse Services (OASAS) as the single state agency responsible for the coordination of state-federal relations in the area of addiction services. Section 32.01 of Mental Health Law authorizes the Commissioner to adopt and promulgate any regulation necessary to implement and effectively exercise the powers and perform the duties conferred by Article 32 of the Mental Hygiene Law. Section 32.07 (4) (e) of the NYS Mental Hygiene Law discusses the regulatory power of the Commissioner and gives “the Commissioner, in consultation with the Commissioner of Health, the ability to adopt standards including the necessary rules and regulations including ……..determining the necessity or appropriate level of admission, controlling the length of stay and the provision of services, and establishing methods and procedures for making such determination.”  OASAS regulations provide for the use of the LOCADTR 2.0 or equal, to determine the level of care placement.

 

So…by law OASAS has the authority to determine medical necessity utilizing LOCADTR 2.0 or equal. Therefore, if we amend existing NYS Mental Hygiene Law to include a provision which states; All insurance companies doing business in NYS are required to use NYS Level of Care determinator , the LOCATDR 2.0 or any tool approved by OASAS, when making medical necessity decisions and level of care recommendations.

How else can we further expand existing NYS Law to insure NYS residents with Substance Use Disorder (SUD) will receive

appropriate care within the guidelines of Federal Parity?  To answer this question let us first look at how NYS currently defines medically necessary treatment.

 

  • According to NYS Social Services, 365-a, New York Law defines “medically necessary medical, dental, and remedial care, services, and supplies” in the Medicaid program as those necessary to prevent, diagnose, correct, or cure conditions in the person that cause acute suffering, endanger life, result in illness or infirmity, interfere with such person’s capacity for normal activity, or threaten some significant handicap and which are furnished an eligible person in accordance with State Law.

 

Officials in the state’s Medicaid agency report that this definition applies to both fee-for-service and managed care populations.

 

In this definition lies a problem. These criteria are not sufficiently clear or unambiguous.

 

Today I would like to recommend we develop a new definition of medical necessity for NYS law that would be a model definition of Medical Necessity meeting the needs of the residents and the State.

 

I am going to give you examples of what 2 States have implemented that have been upheld over time and proven not to cost those States considerable money:

In 1999 The Stanford Research Project presented preliminary findings to a workshop of key stakeholders in California and developed a model definition for medical necessity that was adopted by State Medicaid Program and private plans.

They defined “Medical Necessary” shall mean health care services that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating, an illness, injury or disease or its symptoms, and that are;

a) In accordance with generally accepted standards of medical practice.

b) Clinically appropriate, in terms of type, frequency extent, site and duration, and considered effective for the patients illness, injury or disease.

c) Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic result for the diagnosis or treatment of that patient’s illness, injury or disease.

 

For our consideration today “generally accepted standards of medical practice” mean standards and guidelines outlined by our own NYS Department of Health, NYS Office of Alcohol and Substance Abuse Services and NYS Office of Mental Health.

 

Another example: In 1988 Pennsylvania enacted Act 152 legislation under the Department of Public Welfare which established placement criteria for use by Drug and Alcohol Programs “governing the type, level, and length of care or treatment” of drug and alcohol clients including hospital detoxification, as basis for standards for services provided. This criteria was updated in 1999 with the development of Pennsylvania Client Placement Criteria which remains in effect today. In 1989 Pennsylvania enacted ACT 106 which to date remains hugely successful and has been upheld through passage of Federal Parity.  PA Act 106 requires all commercial group plans, HMO’s and Children’s Health Insurance to provide mandated minimums on detox, rehab and outpatient treatment when authorized by a licensed physician or licensed psychologist and referred to a licensed in-state program.

 

This Law not only meets Federal Parity requirements but exceeds them, has been upheld, and remains in effect today.

 

The recommendation for a new definition of medical necessity is all about unifying the language when anyone writes a policy to provide insurance coverage for New Yorkers. This step will cost NYS exactly “zero dollars” to the taxpayer and if done appropriately will reduce premiums and costs to the plans by keeping people out of emergency rooms with overdoses, heart attacks caused by drug use, countless admits due to alcohol and drug related accidents, and less dollars needed to fund the criminal justice system.  Simple language levels the playing field and is good social policy for NYS.

 

How often does the Legislature get to craft policy that saves lives, supports the health and welfare of the citizenship and does not cost the taxpayers a single dollar!

 

Thank you for your time and consideration.

Sincerely,

Nancy Beckett-Lawless

Rules to Require Equal Coverage for Mental Ills November 8, 2013

ny-times-title

WASHINGTON — The Obama administration on Friday will complete a generation-long effort to require insurers to cover care for mental health and addiction just like physical illnesses when it issues long-awaited regulations defining parity in benefits and treatment.

The rules, which will apply to almost all forms of insurance, will have far-reaching consequences for many Americans. In the White House, the regulations are also seen as critical to President Obama’s program for curbing gun violence by addressing an issue on which there is bipartisan agreement: Making treatment more available to those with mental illness could reduce killings, including mass murders.

In issuing the regulations, senior officials said, the administration will have acted on all 23 executive actions that the president and Vice President Joseph R. Biden Jr. announced early this year to reduce gun crimes after the Newtown, Conn., school massacre. In planning those actions, the administration anticipated that gun control legislation would fail in Congress as pressure from the gun lobby proved longer-lasting than the national trauma over the killings of first graders and their caretakers last Dec. 14.

“We feel actually like we’ve made a lot of progress on mental health as a result in this year, and this is kind of the big one,” said a senior administration official, one of several who described the outlines of the regulations that Kathleen Sebelius, the secretary of health and human services, will announce at a mental health conference on Friday in Atlanta with the former first lady Rosalynn Carter.

While laws and regulations dating to 1996 took initial steps in requiring insurance parity for medical and mental health, “here we’re doing full parity, and we’ve also taken steps to extend it to the people covered in the Affordable Care Act,” the senior official said. “This is kind of the final word on parity.”

With the announcement, the administration will make some news that is certain to be popular with many Americans at a time when Mr. Obama and Ms. Sebelius have been on the defensive for the bungled introduction of the insurance marketplaces created under the Affordable Care Act.

According to administration officials, the rule would ensure that health plans’ co-payments, deductibles and limits on visits to health care providers are not more restrictive or less generous for mental health benefits than for medical and surgical benefits. Significantly, the regulations would clarify how parity applies to residential treatments and outpatient services, where much of the care for people with addictions or mental illnesses occurs.

Any geographic or facility-type limitations would have to be comparable for medical and mental health benefits. For example, an administration official said, an insurer “can’t say you can only get substance-abuse treatment in state but you can go anywhere for medical/surgical.”

The regulations, which specifically put into effect the 2008 Mental Health Parity and Addiction Equity Act, would affect most Americans with insurance — roughly 85 percent of the population — whether their policies are from employer plans, other group plans, or coverage purchased in the market for individual plans.

The final parity rules do not apply to health plans that manage care for millions of low-income people on Medicaid. However, the administration has previously issued guidance to state health officials saying that such plans should meet the parity requirements of the 2008 law.

The parity law does not apply to Medicare, according to Irvin L. Muszynski, a lawyer at the American Psychiatric Association.

The rules have been awaited since the 2008 law by patient advocate groups. As it happened, the groups’ complaints about regulatory delays were the subject of a Senate hearing on Thursday. Interest picked up further last month as individuals could begin enrolling in the new insurance marketplaces, or exchanges, provided under Mr. Obama’s health care law.

Under that law,treatment for mental health and substance abuse is among 10 categories of benefits considered essential and thus mandatory in plans marketed in the new exchanges to individuals and small groups. Although many insurers already provide extensive mental health coverage, some have found ways to get around existing rules and to deny payment for treatment, or to otherwise limit the benefits.

Senator Richard Blumenthal, Democrat of Connecticut, said the five-year delay in issuing a final rule had real-world consequences. “In mental health, uncertainty kills,” he said. “If an individual poses a threat to himself or others, he cannot be told he will get the care he needs as soon as his insurance company decides what ‘parity’ means.”

Insurance companies have raised concerns about the expense involved in paying for the lengthy and intensive courses of treatment that the final regulations address. But experts have said the rules are not expected to significantly add to the cost of coverage because so few patients require these levels of care.

Mental health services are scarce in many parts of the country, particularly for children, so experts have questioned whether changes in the law will have much impact in practice.

Former Representative Patrick J. Kennedy of Rhode Island, a co-sponsor of the 2008 law, said the rules could particularly help veterans. “No one stands to gain more from true parity than the men and women who have served our country and now need treatment for the invisible wounds they have brought home from Iraq and Afghanistan,” he said.

Administration officials consulted closely with mental health groups. “What we are hearing is very positive,” said Andrew Sperling, a lobbyist at the National Alliance on Mental Illness, based on what he had been told of the final language.

Under the 2008 law, treatment limits — like restrictions on the number of doctor visits or days in a hospital — cannot be more restrictive for mental health benefits than for medical and surgical benefits. But interpretation of the law left much in question.

For example, Mr. Sperling said, policyholders can easily determine whether numerical limits on doctor visits are comparable in their plans for mental and medical health care. But, he said, it is more difficult to challenge “nonquantitative limits” — like some insurers’ requirements that people get their authorization before seeing a psychotherapist.

The provision of the rule that will seek to clarify the amount of transparency required of health plans “is important,” Mr. Sperling said. Patients advocates say they need to be able to see the criteria by which insurers find a particular service to be medically necessary, so policyholders can judge whether standards for mental health treatments are more restrictive.

Carol A. McDaid, the leader of a coalition of patients and providers of mental health and addiction services, said: “This is the beginning, not the end, of our work to make the vision of the law a reality. We have to make sure that the law and the rules are fully enforced.”

Insurers and business trade groups said they did not know enough about the rules to comment.

Dr. Paul Summergrad of Tufts University, president-elect of the American Psychiatric Association, said he hoped the final rules would end “the uniquely discriminatory form of prior authorization and utilization review” applied to emergency care for patients with mental illness.

A person who has a heart attack or pneumonia and goes to a hospital will routinely be admitted, with electronic notice sent to the insurer on the next business day, Dr. Summergrad said. By contrast, he said, if a person who is profoundly depressed and tried to commit suicide goes to a hospital, an emergency room doctor must call a toll-free telephone number, “present the case in voluminous detail and get prior authorization.”

State insurance commissioners will apparently have the primary responsibility for seeing that commercial insurers comply with the parity standards. They already have their hands full, however, enforcing new insurance market rules, and in some states insurance regulators are considered close to the industry.

“We need enforcement,” Mr. Kennedy said in an interview. “The notion of delegating this to the states, which are looking to the federal government for direction, is problematic.”

 

http://www.nytimes.com/2013/11/08/us/politics/rules-to-require-equal-coverage-for-mental-ills.html?hpw&rref=health&_r=0

Can Non-Profit Organizations Compete?

MonicaOss_blue 300 copyI’ve had some very interesting discussions over the past few weeks about the role—and competitiveness—of non-profit versus for-profit organizations in the health and human service field. On one hand, with tax-exempt status and no shareholders to satisfy, non-profit organizations should be able to compete with no problem. I’ve had many an executive of a non-profit organization state that they don’t see how a for-profit organization could take their place in a particular market.

In fact, the share of the dollars in the market that are either managed by or delivered by for-profit organizations is on the increase. This raises comments that for-profit organizations are taking the “cream” (to borrow a rural expression) in the market and leaving non-profit organizations with the segments of the market that are underfunded. At the same time, those for-profit organizations are paying their managers and service delivery staff far more than their non-profit competitors.

I think these perspectives on the current environment are due to some very fundamental changes in financing, reimbursement, and contracting. The market for health and human services is moving from a negotiated contract, cost-plus purchase model to a competitive purchase model. A situation that has caused the field, which has long been dominated by non-profit organizations, to have a growing footprint of for-profit organizations in all roles.

One of the legacies of the dominance of non-profit organizations is the creation of unrealistic funding expectations on behalf of many public payers. This is due, in large part, to many non-profit organizations not knowing their actual costs of operation in general and services in particular – and being willing, as good mission-based entities, to subsidize those services in a number of creative ways. The juxtaposition of the competitive market model with unrealistic payer expectations has created an interesting market phenomenon – for-profit organizations are “winning” the competition for services that are adequately funded (due to better productivity, economies of scale, marketing, cost management, etc.) leaving the non-profit organizations with a number of marginally-funded service opportunities.

Why is this happening? My observation is that many non-profit executive teams and boards are making decisions to accept underfunded contracts because they are focused on short-term survival. This has caused erosion of endowments by supplementing operating losses – a situation that is not sustainable in the long run. A great analysis of this phenomenon is The Nonprofit Starvation Cycle, a 2009 article in the Stanford Social Innovation Review. The article’s theme is that funding misconceptions have led to “a vicious cycle…leaving nonprofits so hungry for decent infrastructure that they can barely function as organizations – let alone serve their beneficiaries….In response to pressure from funders, nonprofits settle into a ‘low pay, make do, and do without’ culture.”

The authors also discuss the “big elephant” in the room – overhead. “The final driver of the cycle that starves nonprofit infrastructure is nonprofits’ routine misrepresentation of how much they actually spend on overhead.” How rampant is this? The authors report that a third of organizations report no fundraising costs, an eighth report no management or general expenses, and 75% incorrectly report grant costs. Whether this underreporting of overhead expenses is intentional or not, the implications are the same. It leads to unrealistic expectations on the part of funders. “Funders do not know what overhead rates should be….As a result, funders routinely require non-profits to spend unhealthily small amounts on overhead,” according to the authors. Or funders expect non-profit organizations to absorb the overhead costs as an ‘unfunded’ expense.

There are many non-profit organizations that operate with the same management rigor as their for-profit competitors. But, there are also a significant number that accept service contracts with unreasonably low (and unprofitable) contract rates – and further public funders unrealistic rate expectation. This is a self-perpetuating market cycle that I think is bad for the sustainability of the service delivery system, and bad for the consumers they serve.

Source:  OpenMinds, Writer Monica Oss, President

OPRA and PRESCRIPTIONS

eMedNY

ATTENTION!!! IMPORTANT PRESCRIPTION INFORMATION

 

Prescribers failing to enroll in NYS Medicaid will impact patients’ ability to obtain their medications.

 

Effective October 1, 2013, a pharmacy will NOT be able to fill any prescription written for an individual with Medicaid where the prescriber is not enrolled in NYS Medicaid.  This applies to both new prescriptions and refills.

 

Prescriptions written by prescribers that are not enrolled in NYS Medicaid will deny at the point-of-service.   A pharmacist cannot override a rejected transaction if the prescriber is not enrolled.

 

NYS Medicaid enrollment forms and information: https://www.emedny.org/info/ProviderEnrollment/index.aspx

Open Enrollment in NY Insurance Exchange Begins October 1

NewYorkStateHealth

This is a reminder that open enrollment in the state insurance exchange, New York State of Health (http://www.nystateofhealth.ny.gov/), begins October 1st. Insurance coverage through the exchange will be effective January 1, 2014.

The NY State of Health website has several helpful documents which we encourage you to review, share with staff and consumers as appropriate (http://www.nystateofhealth.ny.gov/resources?f[0]=field_resource_type%3A3).

Each region of the state has local Exchange Navigators who will be available to assist employers and individuals in understanding coverage options through the exchange (http://www.nystateofhealth.ny.gov/resources?f[0]=field_resource_type%3A81). We encourage you to reach out to local navigators following October 1, especially as you assist uninsured consumers who need to find coverage.

We will certainly discuss the exchange and its implications at next week’s public policy retreat and annual membership meeting (go to www.asapnys.org for more information), we hope many of you will be joining us. Our Monday public policy calls will also serve as an opportunity to discuss the roll out of the exchange and identify any issues with navigating the system and enrollment.

Please feel free to contact us with specific questions you might have about the exchange in the days and weeks ahead.

What’s the future of drug policy? An interview with America’s ‘Drug Czar’

By Harold Pollack

drug-czar

R. Gil Kerlikowske delivers opening remarks commemorating the first annual National Above The Influence Day at the Newseum in Washington, D.C., on Oct. 18. (Bryan Whitson for The Washington Post)

Gil Kerlikowske is director of the White House Office of National Drug Control Policy (in more common parlance, America’s “Drug Czar.”) He was recently nominated to be commissioner of Customs and Border Protection. So this is an especially good moment to take stock of U.S. drug policies on several fronts. I caught up with Kerlikowske by e-mail. Below is our lightly edited exchange.

Harold Pollack: What would you say has been the Obama administration’s most important accomplishment in substance abuse policy since you took office? Conversely, what would you describe as your greatest disappointment in this contentious area?

Gil Kerlikowske: There are many areas in which we’ve made great progress. Our comprehensive approach to the prescription drug abuse epidemic is resulting in the first decline in the number of Americans abusing prescription drugs in a decade. Cocaine and meth use are also plummeting. The implementation of the Affordable Care Act is also important, because it will require a public health approach to substance use disorders in America by mandating insurance companies to treat addiction the same way they would any other disease.

We’ve worked hard to change the dialogue when it comes to evidence-based criminal justice reform. Expanding programs like drug courts that divert nonviolent offenders into treatment instead of prison is one example. By signing the Fair Sentencing Act into law, President Obama finally reduced the longstanding disparity between crack and powder cocaine sentencing and eliminated the first mandatory minimum drug law in 40 years. Building on that record, Attorney General [Eric] Holder’s recent announcement in how the Department of Justice addresses mandatory minimums for nonviolent offenders and compassionate release is also historic, and I’m proud to have played a role in tackling that issue.

But there’s much more work to be done. Today, only 1 in 10 Americans who need treatment ever receive it, and the number of people dying from drug-induced deaths remains far too high. We’ve got to do a better job of reframing drug policy as a public health issue and not just a criminal justice issue, and in so doing continue to let science and evidence be our guide.

HP: I was surprised that you didn’t mention one disappointment, which is the limited budget. The Obama administration has reframed the rhetoric of drug control policy. Yet the dollars, particularly in the area of prevention, haven’t really been there to implement ambitious new efforts. Budgets are particularly tight under the sequester, but this has been a chronic problem. Where are we under-investing in drug policy?

GK: First – It’s important to note that despite the conventional wisdom in this area, the federal government actually spends more on prevention and treatment than it does on domestic U.S. drug law enforcement and incarceration. While that breakdown does not include interdiction or support for international programs, the fact still remains that we spend more in one year on demand reduction efforts than we have, for example, on the entirety of Plan Colombia over eight years or in total counternarcotics aid for Mexico’s Merida initiative.

Additionally, the president’s most recent budget includes a requested increase of $1.4 billion for treatment for FY 2014 — the largest such percentage increase for treatment in at least two decades. Our support for prevention remains strong and we’re very engaged with Congress to ensure they continue to support important prevention programs like our Drug Free Communities program, which supports hundreds of community coalitions at the local level. It is true that interdiction is largely a cost born by the federal government and thus more expensive, accounting for a large percentage of federal drug control spending. However, the work of the Coast Guard and Border Patrol are vital not just to public safety but also to public health, and they will always remain a piece of our comprehensive strategy.

Health reform

HP: In a few months, health insurance marketplaces will be open for business in 50 states. Medicaid will expand in about half the states, as well. Mental health parity and expanded substance abuse coverage are important parts of health reform. Are states ready to go with this? Are substance abuse providers ready? How is the implementation process going in this area?

GK: We’re working very closely with the Department of Health and Human Services and stakeholders to ensure treatment providers are ready for ACA implementation. This has been a long process. Since the ACA was passed, we’ve been providing guidance, technical assistance, and are in close touch with the field to ensure the field is ready. Providing treatment for substance use disorders is important and will also save costs moving into the future.

HP: Millions of low-income people are both uninsured and experience drug or alcohol disorders. Many live in states that have opted out of the Affordable Care Act’s Medicaid expansion. What are states and the federal government doing to meet the needs of this population in non-expansion states?

GK: If states don’t expand their Medicaid programs, a lot of low-income working families and some of our country’s most vulnerable would be left no source of affordable health coverage at all – including for substance use disorders. We can’t let that happen. There’s money left on the table and lives left at risk. And no one’s health should depend on their Zip code.

Sentencing reform

HP: Attorney General Holder recently spoke of the need for less punitive sentencing of nonviolent offenders on the supply-side of the drug market. He directed U.S. attorneys to use their discretion to advance this goal. Of course, the great majority of drug offenders are outside the federal system. What can states and localities do to focus more closely on more violent or more important drug-sellers? Should ONDCP take this issue on as one of its core missions?

GK: Absolutely, and we are, as the attorney general mentioned in his speech. In fact, more than 17 states and 18 counties are in various stages of significant criminal justice reform. As you can imagine, change like this takes time, but states and localities are moving in the right direction by supporting alternatives for low-level, nonviolent drug offenders while reinvesting in smarter supervision strategies, treatment, and other services. That’s what real drug policy reform looks like. And we’re seeing historic movement in this area. For the first time in 40 years, we’re seeing a decline in the number of people in state prisons.

It’s worth noting that these reforms have broad bipartisan support. We’re seeing progress in both red and blue states – from Texas, Georgia and Kentucky to Ohio, Pennsylvania and Connecticut.

International matters

HP: Tens of thousands of people have died in Mexico in recent years as drug-selling organizations battle each other and the Mexican government. What can the U.S. government do to lessen this violence, and more fundamentally to induce less violent business models among the organizations that smuggle drugs into this country?

GK: We’re determined to meet our responsibilities to reduce the demand for illegal drugs. The good news is that since 2006, there has been a significant decline in cocaine use in the U.S. of over 40 percent and meth use has been cut by a third. Moreover, our border with Mexico is more secure than in history due to the unprecedented resources this administration has placed there.

Every country has a drug consumption problem and our balanced approach is, in part, what our friends in this hemisphere have requested: that we focus on reducing our own consumption of drugs. We also have been sharing our experience with drug courts; diverting nonviolent drug users into court-supervised drug treatment programs. We have invited our Mexican partners to visit and see the Drug Courts in action and to return to Mexico to shape effective Drug Courts to the needs of Mexico.

It’s worth noting that the violence in Mexico is perpetrated by organizations that are not just “drug-trafficking organizations,” but rather Transnational Criminal Organizations who engage in a diverse range of illegal activities. They not only move drugs to the United States but also fuel the drug market in Mexico and in many instances pay for services (with drugs) in kind. Alejandro Junco, a distinguished Mexican journalist and owner of Grupo Reforma, made another compelling point: Once the dominating cartel establishes territorial control, it turns to the most profitable part of its operation — selling protection to local businesses. Kidnappings, extortion, piracy, contraband, prostitution — cartels will turn to almost anything illegal that makes money. So, the suggestion that drug legalization would cause transnational organized crime to dissolve is just a distraction.

HP: The last time you and I spoke, I moderated a conversation in Chicago with your Russian counterpart, Viktor Ivanov. Ivanov wanted the United States to pursue mass crop eradication in Afghanistan. You responded that Afghanistan is a sovereign country which does not wish us to pursue such policies. Afghanistan is a dominant supplier in the opium market. How is the United States government approaching that problem?

GK: Supporting the government of Afghanistan’s counternarcotics efforts remains a priority for the United States. It is an integral part of our stability and security strategy for the region. We support Afghan-led eradication as a law enforcement tool to reduce and deter subsequent year poppy cultivation. Afghan-led eradication has been especially effective at the local level where local leaders and communities are involved in the eradication process. When eradication is implemented as a continuum of supply reduction activities and coupled with alternative development, it has proven effective in deterring cultivation and transitioning farmers away from poppy.

At the same time, we recognize that eradication is not the only solution to the drug problem in Afghanistan; it is one tool in the supply reduction toolkit that can be leveraged to reduce and prevent cultivation. In addition to eradication, we also support other law enforcement measures, including interdiction, judicial reform and capacity building, demand reduction efforts and treatment centers, public information campaigns and alternative development.

Marijuana

HP: California and Massachusetts are among the states that decriminalized marijuana during the Obama administration. Prior administrations campaigned actively against states doing this. The current administration did not. Why not?

GK: As you noted previously, the vast majority of drug enforcement happens at the state and local level and not the federal level. Many states are looking at various alternatives to incarceration. With regard to the federal position, the administration’s position has been clear and consistent: While the prosecution of drug traffickers remains an important priority, targeting individual marijuana users is not the best allocation of federal law enforcement resources.

HP: The president has announced his desire to find some accommodation between the Controlled Substances Act and the new laws in Colorado and Washington. How does the administration plan to do this?

GK: This is a question for the Department of Justice, which is currently reviewing this issue.

Generally speaking, however, both President Obama and I have been clear and consistent in our opposition to legalization. This stems from the fact that legalization runs counter to a public health approach to drug policy.

HP: You say that “legalization runs counter to a public health approach to drug policy.” Most experts I know tend to avoid that term. They speak of more granular changes, typically on the demand rather than the supply side of illicit markets. For example, many favor removal of criminal penalties for possession of relatively small amounts of marijuana for personal use but would not allow a fully-legitimate market that includes industrial-scale production, national distribution and marketing as we see for alcohol or cigarettes. As our society gropes for some compromise on the marijuana issue, is there some less extreme way to pose things that moves away from a supposed choice between drug warriors and legalizers in this debate?

GK: When we released our drug policy reform plan we made clear that we need to move to a 21st century approach to this challenge instead, one that offers evidence-based alternatives based on realistic goals. There are a whole host of alternatives to incarceration we are actively supporting that move away from those extremes. Drug courts, which are referring over 120,000 nonviolent drug offenders into treatment instead of prison a year is a good example. The Drug Market Intervention model is another, which separates low-level offenders from higher-level offenders and connects them to services instead, in so doing providing low-level offenders with a second chance instead of burdening them with a criminal record that follows them for the rest of their life.

Is the culture war over in drug policy?

HP: In the prior administration, ONDCP officials condemned organizations that distributed naloxone to prevent opioid overdoses. The current administration has given such organizations awards. What do you think accounts for this change?

GK: When President Obama first took office he made it very clear to all of us that when it comes to policymaking decisions – particularly those that impact public health and safety – science and evidence should be our guide, not ideology or dogma. We know that prevention and treatment remain the most cost effective and humane ways to reduce drug use and its consequences in America, but we have to also acknowledge that there are other tools we can also use that save lives and help guide people into treatment.

One of those tools is naloxone – a lifesaving drug that has been proven to reverse overdose. One police department in Quincy Massachusetts has already reversed over 175 overdoses since 2010 using Naloxone. Given the fact that drug-induced deaths are now the second leading cause of injury death in the U.S. we have a responsibility to employ every tool we have in our work to save lives.

HP: Listening to that conversation in Chicago, I was also struck by the contrast between you and your Russian counterpart. Ivanov opposed syringe exchange and methadone maintenance. You responded that both approaches were helpful in preventing HIV and in reducing drug use. That’s not the way your predecessors spoke 20 years ago, when drug policy was a raging front in the culture wars.

I’m also struck that many conservatives and Republicans who might once have attacked (say) Holder were conspicuously quiet this time. Libertarians such as Rand Paul have spoken out against mandatory minimum sentences. Conservatives such as Grover Norquist, Newt Gingrich and even William Bennett associate with groups like Right on Crime that have also supported more moderate sentencing policies. President George W. Bush was not an angry politician on this front, either.

This long windup leads me to a simple question: Is the culture war over in drug policy?

GK: We have worked hard over these last several years to do just that. Science provides all of us with a clear path on how to pursue real drug policy reform. Research demonstrates that addiction is a disease of the brain that can be prevented, treated and recovered from – it is not a moral failure on the part of the individual. It hinges on a complex set of genetic, environmental and behavioral factors. It is also a unique disease in that too many people who suffer from it do not seek help on their own, and eventually end up coming into contact with the criminal justice system.

This is not my opinion or a political statement – it’s a fact – and provides the foundation for which everyone should be working from when it comes to drug policy. It also serves as the basis for the administration’s 21st century approach to drug policy reform, which rejects both the extremes of a law-enforcement-centric “war on drugs” on the one hand and drug legalization on the other – both of which run counter to this science-based approach.

The president has outlined his vision of an America built to last — where an educated, skilled workforce has the knowledge, energy and expertise to compete in the global marketplace. Yet for far too many Americans, that vision is limited by drug use, which not only limits the potential of the individual but jeopardizes families, communities and neighborhoods.

The good news is that we know we are not powerless against this challenge. Today, there are 23 million Americans in recovery from a substance use disorder. These folks are our family members, they are out co-workers and they are our neighbors. They’re also living proof that by pursuing smart approaches, we can make America healthier and safer.

Press Release: New York Health Benefit Exchange Announces New Name and Health and Dental Plans to be Offered

nyhealthplan

ALBANY, N.Y. (August 20, 2013) – State Health Commissioner Nirav R. Shah M.D., M.P.H., today announced the new name for the New York Health Benefit Exchange, ‘NY State of Health.’ The launch of the new name and logo (included below) is an important milestone for communications around the exchange, which will open for enrollment on Oct. 1, 2013.

“The NY State of Health name reflects our commitment to deliver what the exchange is all about –a marketplace that will provide quality, affordable health insurance for individuals and small businesses across the state,” said Commissioner Shah.

The brand and logo were developed by advertising agency, DDB New York, and is the first reveal in a campaign that will air across New York media beginning Oct.1. The brand is anchored in a mantra that defines what it is to be a New Yorker; visit www.nystateofhealth.ny.gov.

“In creating a name, we wanted it to be meaningful, memorable and capture the essence of what it is to be a New Yorker – that unique ‘can do’ attitude and state of mind,” said Donna Frescatore, NY State of Health’s executive director. “Across the state, there’s a growing sense of excitement as we move closer to enrollment. We’re confident the ‘NY State of Health’ name and campaign will inspire New Yorkers who are uninsured or underinsured to explore the options and choose the plan that fits their needs.”

Also announced today were the insurers that will offer health and dental plans to individuals and small business owners when NY State of Health opens for enrollment on Oct. 1. The New York State Department of Financial Services announced on July 17 the approved health insurance plan rates for insurers seeking to offer coverage in New York’s exchange marketplace.

“By assuring access to quality, affordable health insurance, NY State of Health will play an essential role in making New York the healthiest state in the nation,” said Commissioner Shah. “As a result of Governor Cuomo’s leadership, individuals and small businesses will soon be able to choose from a variety of plans to suit their needs.”

The health plans that will be offered in NY State of are:

  • Affinity Health Plan, Inc.
  • American Progressive Life & Health Insurance Company of New York (Today’s Options of NY, Inc.)
  • Capital District Physicians Health Plan, Inc.
  • Health Insurance Plan of Greater New York (EmblemHealth)
  • Empire BlueCross and Empire Blue Cross Blue Shield
  • Excellus (Excellus Blue Cross Blue Shield in Central NY and Univera in Western NY)
  • Fidelis Care
  • Freelancers Co-Op (Health Republic Insurance)
  • Healthfirst New York
  • HealthNow New York, Inc. (Blue Shield of NENY; Blue Cross Blue Shield of Western NY)
  • Independent Health
  • MetroPlus Health Plan (Market Plus)
  • MVP Health Plan, Inc.
  • North Shore LIJ
  • Oscar Insurance Corporation
  • United Healthcare of New York, Inc. (United, Oxford)

 

The dental plans that will be offered in NY State of Health are:

  • Delta Dental Insurance Company
  • Dentcare
  •  Dentegra Insurance Company
  • Emblem
  • Empire BlueCross and Empire Blue Cross BlueShield
  • Guardian
  •  HealthNow New York, Inc. (Blue Shield of NENY; Blue Cross Blue Shield of Western NY)
  •  Healthplex
  • MetLife
  •  Solstice

 

An interactive map that shows health plans by county is available at: www.nystateofhealth.ny.gov/PlansMap

 

Plans offered in NY State of Health will be available in four easy-to-compare metal tiers (platinum, gold, silver and bronze). Plans on the Marketplace will cover doctor’s visits; hospital stays; emergency care; maternity and newborn care; mental health and substance abuse disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services, chronic disease management and pediatric dental and vision. Some plans will offer additional benefits such as adult dental and vision coverage.

Individuals and families with incomes below certain levels ($45,960 for individuals and $94,200 for a family of four) may be eligible for financial assistance in the form of federal tax credits only available through NY State of Health. Federal tax credits limit the amount a person pays for insurance each month. Monthly payments will be far below the cost of buying insurance today. For example, if a silver level plan is selected, an individual with an annual income of $17,000 will pay $55 per month; a family of four with an income of $35,000 will pay $114 per month.

In addition, starting today, New Yorkers may use the calculator on the NY State of Health website (nystateofhealth.ny.gov) to estimate their eligibility for tax credits; see: www.nystateofhealth.ny.gov/PremiumEstimator

NY State of Health will offer New York’s small businesses with 50 or fewer employees a range of coverage options and ease the administration of employee benefits for owners. Moreover, NY State of Health will be the only place where small businesses with 25 or fewer employees and average wages of $50,000 or less per year may qualify for tax credits to reduce the cost of providing coverage.

Insurance coverage begins Jan.1, 2014. It is estimated that at full enrollment nearly 1.1 million New Yorkers will obtain insurance through NY State of Health, including 615,000 individuals and 450,000 employees of small businesses.

For more information, visit the NY State of Health website at nystateofhealth.ny.gov and on Facebook, Twitter or Google+.

NYS Moves Timeline Forward for Transition of Behavioral Health Services

On behalf of the Office of Alcoholism & Substance Abuse Services Commissioner Arlene Gonzalez-Sanchez, Office of Mental Health Acting Commissioner John Tauriello, and myself, I would like to provide you with the following update on the timeline for transition of Behavioral Health services:

The NYS Behavioral Health (BH) Transition Team for Medicaid, comprised of leads from OASAS, OMH, and DOH, is updating the target dates for implementing the transition of BH services.

The Medicaid Redesign Team (MRT) recommended a careful and responsible transformation of the current fee for service system to Medicaid Managed Care for Medicaid enrolled individuals with Substance Use Disorder (SUD) and Mental Health (MH) treatment needs. To implement this recommendation, program design features are being carefully constructed and revised based on feedback from a variety of key sources including BH providers, Medicaid members, MMC Plans, other states with successful track records, and the State’s consultants.  While no major changes have been made to publicly discussed plans, this critical feedback on details related to program features, baseline data and rate development activities is creating some delays as the team carefully constructs this very important product.

Accordingly, this review and revision will delay final Request for Qualification (RFQ) specifications and HARP and Non-HARP rate development.  As previously discussed the RFQ timing is key as the RFQ will qualify Plans as approved to manage the State Plan and new waiver-like BH services on their own or in partnership with a BHO and will establish qualification parameters for Health and Recovery Plans (HARPs) for individuals with higher levels of SUD and MH treatment and support needs.

The new implementation dates are listed below and will afford NYS the opportunity to:
1. Provide Medicaid Managed Care Plans and Behavioral Health Providers more time to prepare for this major improvement in the way we provide health care to some of our most vulnerable citizens;
2. continue to work with stakeholders, families and consumers to understand and give us feedback on this major change and to help us better leverage important community based services in the design;
3. allow for more time to develop key performance measures for this transition and new operation;
4. allow more time to obtain needed Federal approval for these new services and design and
5. allow DOH, OASAS, and OMH to continue working on reasonable and efficient plan and service payment rates with the State’s actuary.
Revised Implementation Dates:

  • January 1, 2015:    Implementation BH Adults in NYC (HARP and Non HARP)
  •  July 1, 2015:           Implementation BH Adults in Rest of State  (HARP and Non HARP)
  • January 1, 2016:    Implementation BH Children Statewide

Thank you for your continued support for this critical undertaking.  We look forward to eventually leading the nation in providing the best possible care to individuals with behavioral health conditions.

Jason Helgerson
Medicaid Director

Behavioral Health Transition Timeline (August 2013)

 

Quit Alcohol Website

QUIT-ALCOHOL

People searching for treatment are always curious about cost, and whether insurance will cover the bill. Most others providing this information are looking to generate clients.

QuitAlcohol.com is part of the USA Addiction Treatment Partnership. Check them out at http://www.quitalcohol.com/health-insurance-and-addiction.html

OASAS Criminal Background Checks – Justice Center Staff Exclusion List

Justice Center 8.8

TO: Providers within Justice Center SEL Check Jurisdiction
FROM: Jeff Wise, Executive Director
DATE: August 6, 2013
SUBJECT: Interim Process: Provider Staff Exclusion List Checks

As you know, the Justice Center is responsible for maintaining a statewide register known as the Staff Exclusion List (SEL) which will contain the names of individuals found responsible for serious or repeated acts of abuse and neglect. Individuals on the SEL are subject to hiring restrictions as prescribed by law for any state operated, certified or licensed agencies or providers that serve people with special needs. As of June 30, 2013, the law requires most providers to check the SEL prior to allowing a prospective applicant to have regular and substantial contact with a service recipient.

We are cognizant of the fact that no one is currently on the SEL. The Justice Center values the input from the provider community as we work to ensure that people with special needs are protected from abuse, neglect and mistreatment. To alleviate the processing burden associated with checking the SEL, the Justice Center has considered suggestions for changing the SEL check request protocol and has decided to make available an Interim Request for Staff Exclusion List Check page on the Justice Center’s website for providers to access, instead of requiring a SEL check for each individual applicant, until such time as someone is placed on the SEL.

Until a person is placed on the SEL, providers may comply with Social Services Law §495(2), which requires a check of the SEL, by visiting www.justicecenter.ny.gov and clicking on the red banner near the top of the home page, then printing and saving a copy of the dated Interim Request for Staff Exclusion List Check page along with the employment application for each applicant for whom a provider or agency is mandated to conduct a SEL check. This document must be available for auditing purposes by your program’s State oversight agency.

When someone is placed on the SEL, the webpage will change to reflect that fact and providers will then be required to submit an SEL Check Request form for every applicant and receive a Justice Center response before proceeding with the hiring process or otherwise allowing that person to have regular and substantial contact with a service recipient.

Please note: the Justice Center has interpreted the relevant statutory language to provide that an SEL Check Request should only be submitted on a person a provider is seriously considering hiring or otherwise permitting to have regular and substantial contact with a service recipient. An SEL Check Request form should not be submitted for everyone that a provider may interview.

161 Delaware Avenue, Delmar, NY 12054