Links and Resources | January 2014

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A Woman’s Guide to Alcohol and Addiction

 

helpguide

HelpGuide.org: Drug and Substance Abuse Treatment

 

 

 

 

 

samsha

Addiction Recovery Support

Medicare and Mental Health: What’s Covered, What’s Not?

Medicare and Mental Health: What’s Covered, What’s Not?

 

 

 

 

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

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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

Commissioner Arlene González-Sánchez Announces Peer Advocate Certificate in NYS

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FOR IMMEDIATE RELEASE

June 19, 2013

Commissioner Arlene González-Sánchez Announces Peer Advocate Certificate in NYS

New York State Office of Alcoholism and Substance Abuse Services (OASAS) Commissioner Arlene González-Sánchez is pleased to announce that the Florida Certification Board (FCB) has been approved to offer a Peer Advocate Certificate in NYS.

Peer Advocates certified by the FCB will be able to offer peer services in OASAS Certified Outpatient Treatment settings and be reimbursed by Medicaid for such services. One of the first tasks that the FCB will undertake is to establish a New York-Based Advisory Board of subject matter experts who will work hand-in-hand with the FCB to develop Peer Advocate certification, application, testing and review processes. As part of the formal agreement between OASAS and the FCB, the FCB has committed to begin certifying Peer Advocates in NYS within six months.

Commissioner González-Sánchez stated, “This partnership with the Florida Certification Board is an important step for OASAS to further promote a recovery oriented system of care (ROSC) in New York State. It is essential that our system have peer advocates involved in the treatment and recovery process to provide hope as well as life-long community-based services to sustain long-term recovery.”

The FCB has been in operation for 30 years and formally incorporated since 1985. They also provide certifications and testing services for other states including California, Michigan and Illinois. The FCB sets standards for and certifies individuals in various levels of professional occupations including: the addictions arenas of treatment, prevention and criminal justice; mental health including behavioral health peer services; gambling and child welfare.

Neal McGarry, Executive Director of the FCB stated, “The Florida Certification Board is very pleased to be partnering with OASAS in the delivery of certification services for Peer Advocates. It is our intent to assist OASAS in raising the standards of care and professional recognition for Peer Advocates throughout the State of New York. Moving forward in this venture, the FCB will be operating as the “New York Certification Association – Council of Peer Advocates.”

The total number individuals currently credentialed by the FCB, across all professions, is 15,300. Additionally, from April 2012 to September 2012 the FCB operated one of the Substance Abuse and Mental Health Services Administration (SAMHSA’s) Addiction Technology Transfer Centers (ATTC) known as the Southern Coast ATTC whose primary purpose was to provide training, technical assistance and products to transform services, systems and policies to recovery-oriented systems of care (ROSC).

And for all New Yorkers struggling with an addiction—or whose loved ones are struggling—help and hope are available. The State’s toll-free, 24-hour, 7-day a week HOPEline, 1-877-8-HOPENY, is staffed by trained clinicians who are ready to answer questions, offer treatment referrals, and provide other vital resources to facilitate that first step into recovery.

OASAS oversees one of the nation’s largest addiction services systems dedicated to Prevention, Treatment and Recovery, with nearly 1,600 programs serving over 100,000 New Yorkers on any given day.

For more information, please visit www.oasas.ny.gov.

Follow OASAS: www.twitter.com/nysoasas / facebook profile: NYS OASAS www.youtube.com/nysoasas / www.flickr.com/photos/nysoasas

Section 1115 Medicaid Waivers

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Read the PDF below for questions / answers about Section 1115 Medicaid waivers – such as the state’s Super Medicaid Waiver Request.

The Q and A was prepared by Jane Perkins and the National Health Law Program.

http://www.healthlaw.org/images/stories/NHeLP_QA_2013_Wood_1115_APA.pdf

The Collaborative Care Model: An Approach for Integrating Physical and Mental Health Care in Medicaid Health Homes

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States across the country are seeking evidence-based approaches to improve the health care of high-need, high-cost Medicaid populations. Strategies to improve the integration of physical and behavioral health services are essential for these beneficiaries with complex needs as are innovative payment models to cover the costs of care.

 

The collaborative care model offers one approach to integration in which primary care providers, care managers, and psychiatric consultants work together to provide care and monitor patients’ progress. Programs using this model have achieved improved clinical outcomes and reduced costs for a variety of mental health conditions, in a variety of settings, using several different payment mechanisms. This brief, developed by the Center for Health Care Strategies (CHCS) for the Centers for Medicare & Medicaid Services’ Health Home Information Resource Center, details the collaborative care model as an option for implementing integrated care under Medicaid health homes made possible through the Affordable Care Act (Section 2703). It was written by Dr. Jürgen Unützer of the University of Washington in collaboration with experts across the country.

 

Read the brief >>

 

This brief is a product of the Health Home Information Resource Center, which was created by the Centers for Medicare & Medicaid Services to help states develop new models of care that coordinate the full range of medical, behavioral health, and long-term services and supports needed by Medicaid beneficiaries with chronic health needs. The Health Home Information Resource Center is coordinated by Mathematica Policy Research and the Center for Health Care Strategies.

 

States can access one-on-one technical assistance to develop and implement Medicaid health homes from the Health Home Information Resource Center using this link.

ATPA Response to the new, Part 822 Draft Regulations

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The following are comments and concerns regarding the new, Part 822 draft regulations raised at the monthly, clinical review/quality improvement meeting of ATPA held on January 11th, 2013:

  • “Telepractice services may be provided.”  Could this include other forms of evolving online services (e.g., email/text-based sessions, videoconferenced sessions, etc.)? What CPT codes would we use for these services?  Must they be a certain duration?

 

  • How do these new regulations follow the “golden thread” formulation of gold standard treatment?  The new regulations seem to be moving away from this plan (i.e., no comp evals., no medical screening required)

 

 

  • Treatment plans completed no later than 21 days or 5th visit, whichever occurs first.  For someone attending intensive outpatient services, the treatment plan could be due before the second week of treatment not allowing ample time to know the client’s case well.  Is this ample time to adequately assess and develop a recovery plan?  May lead to cookie-cutter, generic treatment plans.  We think 21 days is sufficient, but remove the 5th visit stipulation.

 

  • Having treatment plan reviews signed by the medical director is difficult and time consuming.

 

 

  • There must be “an adequate number of counselors” to carry out objectives of program.  This ambiguity leads to too much subjectivity both by programs and by OASAS in determining proper outcomes. Specifically state the program outcomes by which OASAS would flag a program.

 

  • “Extended care” is unclear.  Are these patients considered discharged? Are they readmitted as extended care patients?  Do they continue to need treatment plan reviews?

 

 

  • Criteria for discharge is ambiguous.  Please define “stabilized”.  What are the specific “remission criteria for a substance use disorder”?  Is this related to a duration free from substances?  What specifically does it mean to “attain necessary support for long-term remission”?

 

  • Each employee to have a training plan.  Can OASAS provide us with some direction or a format for this?

 

 

  • Have authorized staff for administering a Narcan emergency overdose prevention kit.  Is this really necessary for non-OTP programs?  Would we need an authorized staff available during all clinic hours?

 

The Addiction Treatment Providers Association (ATPA) is composed of licensed and proprietary agencies within New York State that do not receive any deficit-funding from OASAS. Learn more about us at http://www.atpanys.org.

 

Submitted by:

Nick Lessa, LCSW-R, MA, CASAC

Chair of the Clinical Review Committee

Addiction TX Resources for Members of the NYS Council

APTA recommends the following Addiction Treatment Resource:

You never know who needs this information, but we all know that without it senseless deaths will continue to occur.

http://www.supportprop.org

Your Guide to SAMHSA’s Resources

 

The mission of the Substance Abuse and Mental Health Services Administration (SAMHSA) is to reduce the impact of substance abuse and mental illness on America’s communities. SAMHSA has demonstrated that prevention works, treatment is effectiv, and people recover from mental and substance use disorders.

For more information please check out this LINK.

Top NYC drug prosecutor: Epidemic is getting worse

By John M. Annese Staten Island Advance

STATEN ISLAND, N.Y. — Despite a speck of positive news out of Staten Island this week, the city’s prescription drug abuse epidemic is getting worse, said the city’s top drug prosecutor.

Staten Island Advance/Jan Somma-Hammel

Special Narcotics Prosecutor Bridget Brennan speaks at a 2011 Staten Island press conference

with District Attorney Daniel Donovan, left, and Timothy Dewey, chief of the state Bureau of Narcotics Enforcement, right.

“I am sorry to report that the problem has not only failed to level off – it has worsened significantly over the past year,” said Special Narcotics Prosecutor Bridget G. Brennan, in testimony submitted at a City Council budget hearing today. “We are now in the throes of a full-blown epidemic.”

And Staten Island, again, remains the epicenter of the problem, “with the highest rates of prescriptions filled per capita and, correspondingly, it has the highest overdose rates,” she said.

“The good news is that the prescription rate in Staten Island appears to have leveled off, with the number of oxycodone prescriptions in the borough growing by only 3 percent in 2011, as compared to a 21 percent increase in 2010.”

Ms. Brennan is citing state health department data that shows 140,240 oxycodone prescriptions filled by borough residents last year, compared to 136,808 filled in 2010. By contrast, the rest of the boroughs showed increases of between 13 to 16 percent.

Data provided by the state Health Department to the Advance showed a similar trend — large increases in the other four boroughs — with one difference, a 1.5 percent decrease in prescriptions filled. That’s due to the way the information was gathered — Ms. Brennan’s statistics are based on where the patient receiving the prescription resides, while the data provided to the Advance was based on the location of the pharmacies where the prescriptions were filled.

The discrepancy means that Staten Islanders went off-borough to fill at least 17,000 oxycodone prescriptions, at a minimum.

Ms. Brennan also highlighted a heretofore-unpublicized March 2011 arrest made on Staten Island — authorities searched the Pleasant Plains home of Brando Franco, then 34, and found a well-fortified stash house, she said.

Federal agents with U.S. Immigration and Customs Enforcement arrested him and his girlfriend mid-drug deal in Sayreville, N.J., just on the other side of the Outerbridge Crossing, Ms. Brennan said. They found a gun in his girlfriend’s car, and when they got consent to search his home at 6675 Amboy Rd., they found an AR-15 rifle, a 9 mm pistol, body armor, ski masks, sophisticated surveillance equipment, approximately 3,000 oxycodone pills, 30 grams of cocaine, and unspecified amounts of Xanax and anabolic steroids, she said.

A framed poster of Al Pacino’s “Scarface” hung prominently on the wall, Ms. Brennan said. His case is still pending in Manhattan Supreme Court.

Original Article: http://www.silive.com/news/index.ssf/2012/03/top_nyc_drug_prosecutor_epidem.html