Assembly Roundtable: A Comprehensive Approach to the Opioid & Heroin Crisis in NY

assembly

NOTICE OF ROUNDTABLES

SUBJECT:

A Comprehensive Approach to the Opiate and Heroin Crisis

PURPOSE:

To examine and discuss current policies related to opiate and heroin abuse, including treatment options, in order to develop awareness and potential legislation

Albany

Monday, May 12, 2014

11:00 A.M. – 2:00 P.M.

Room 104-A

Legislative Office Building

Albany, NY

New York City

Thursday, June 5, 2014

10:30 A.M. – 1:30 P.M.

Room 2225, 22nd Floor

250 Broadway

New York, NY

Participation by Invitation Only

Illicit opiate and heroin use has sharply increased recently throughout the country, including New York State. There are daily news reports of opiate overdoses, which often result in death. This scourge has especially affected young people throughout the state. These roundtables will examine the problem from a public health perspective and explore solutions including prevention, treatment options and possible legislation. The roundtables will include representatives of groups from across the state, including chemical dependence prevention and treatment providers, physicians, drug policy experts, and law enforcement.

Persons invited to participate at the above roundtable should complete and return the enclosed reply form as soon as possible. It is important that the reply form be fully completed and returned so that persons may be notified in the event of emergency postponement or cancellation. In order to further publicize this roundtable, please inform interested parties and organizations of this upcoming roundtable discussion.

In order to meet the needs of those who may have a disability, the Assembly, in accordance with its policy of non-discrimination on the basis of disability, as well as the 1990 Americans with Disabilities Act (ADA), has made its facilities and services available to all individuals with disabilities. For individuals with disabilities, accommodations will be provided, upon reasonable request, to afford such individuals access and admission to Assembly facilities and activities.

Steven Cymbrowitz

Member of Assembly

Chair

Committee on Alcoholism and Drug Abuse

Richard N. Gottfried

Member of Assembly

Chair

Committee on Health

Joseph R. Lentol

Member of Assembly

Chair

Committee on Codes

SELECTED ISSUES TO WHICH PARTICIPANTS MAY DIRECT THEIR COMMENTS:

• Why has illicit opiate and heroin usage increased so dramatically in recent years?

• What substance abuse treatment options are currently available to opiate and heroin abusers? What more can be done?

• How can awareness be raised regarding chemical dependency and prevention?

• Has the increased availability of opioid antagonists, such as naloxone, helped in preventing fatal opiate-related overdoses? How can the “911 Good Samaritan Act” (Chapter 154 of the Laws of 2011) be further utilized?

• Who are the persons most impacted by illicit opiate and heroin abuse? Is usage widespread, or concentrated or most common in certain communities?

• What can health care professionals, especially those with prescribing authority, do to help curb opiate abuse and addiction?

• What is the role of law enforcement, including police and district attorneys, in combatting opiate and heroin abuse?

• What more needs to be done to raise the awareness of the general public about the opioid and heroin abuse crisis?

ROUNDTABLE REPLY FORM

Persons invited to present comments at the public roundtable examining “A Comprehensive Approach to the Opiate and Heroin Crisis” are requested to complete this reply form as soon as possible and mail, email or fax it to:

Nathaniel Jenkins

Analyst

Assembly Committee on Codes

Room 513, Capitol

Albany, NY 12248

Email:jenkinsn@assembly.state.ny.us

Phone: 518-455-4313

Fax: 518-455-3669

Albany Lobby Day for Access to Care

There is an epidemic here on Long Island with heroin and other opioid prescription pain medications costing us the lives of hundreds of our young people and other family members.  It is getting more and more difficult to get treatment episodes paid for by the insurance companies that are contracted  to cover the lives of individuals.  Something must be done…and the time to do it is now!

There are two bills right now in the Senate (S4623) and Assembly (A7003A) calling for a change to NYS Insurance Law regarding who determines medical necessity, the Insurance Company who has a fiduciary interest in denying care, or a physician or qualified healthcare professional  exercising good clinical judgment.  Access to Care is the issue.

Next Tuesday, May 6th we have an opportunity to go to Albany and let our legislators know we want change and we need their help!  Attached you will find a flyer announcing a Mother’s Day Press Conference which will be held in the afternoon and a morning filled with the chance to visit with those who represent us in Albany.  A bus going from Long Island and you are invited to join in.  All others are welcome to join us there.

Please consider this important event and contact me if you have any questions.  Together we can make a difference.  Our young people need us to lead the way.

MothersDayPress 2014

Support for Access to Care Bills

Important bills to support for the field.

Legislative flyer

For-NY Policy Statement

ATPA SupportLtr

Petition Access to treatment1 (2)

Dear New York State Prevention Services Provider:

 

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

An Update on the OASAS Gold Standard Advisory Committee Meeting

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On February 25th, the Gold Standard Committee met to discuss recent steps taken towards recognizing licensed agencies meeting gold standard quality of care.  Committee members were reminded that the Commissioner considers the Gold Standard initiative very important OASAS.  The agency has begun a pre-pilot, data verification project to ensure that the data being reported by agencies for determining gold standard recognition has validity.

(To achieve gold standard recognition, a provider must have four or more stars, on a 1-to-5 star system, in half or more of the measures and no measures with less than two stars.)

OASAS went on-site to a provider in the Mid-Hudson region, who appeared to have met criteria for Gold Standard recognition, in order to review case records and ensure that the records corroborated the Scorecard ratings of that particular agency.  Fifteen records of discharged cases were reviewed addressing 25 different elements such as admission/discharge dates, discharge dispositions, substance use patterns, and frequency of use.  Out of 15 records reviewed only 2 errors were discovered.  The reviewers had to be thoughtful about where to find the verifiable data that they were seeking.

A discussion about verifying data ensued.  Questions posed by the committee included:

  • What is an acceptable error rate?
  • How are the individual measures weighed?
  • How far does the agency dig into a record for verification?
  • What is a reasonable sample size to review?
  • Does OASAS have the resources to do this?

One suggestion was for providers, who are applying for Gold Standard recognition, to complete a self-assessment checklist followed by a random sample review performed by OASAS.  Another suggestion was to include a patient satisfaction survey as part of the gold standard process using a standardized instrument.  Someone also suggested verifying that a provider applying for Gold Standard recognition is utilizing evidenced-based practices in their treatment protocol.

As a member of the Gold Standard Committee, I will continue to report back on progress made by the committee.

 

Submitted by,

Nick Lessa

nlessa@inter-care.com

The Governor’s Bold Agenda For 2013

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Dear Friend,

Yesterday, Governor Andrew M. Cuomo presented his bold agenda for 2013 at the State of the State Address.Click here to read the full text of the Governor’s address. Check out highlights from his agenda below:

Attract more good jobs and economic growth:

  • Accelerate the commercialization of good ideas and new businesses in our state to create jobs
  • Reform workers’ compensation and unemployment insurance to reduce business costs
  • Make New York a national leader in building a clean tech economy program, including a $1B Green Bank
  • Better match training programs to meet the required skills of available jobs
  • Continue to focus on growing the economy in Upstate New York

Continue to create a world-class education system:

  • Provide students with more learning time through a longer school year or longer days
  • Offer full-day pre-kindergarten in vulnerable communities
  • Recruit and train the best and brightest educators
  • Improve education and resources in New York’s neediest communities

Restore New York as the progressive capital of the nation:

  • Raise the minimum wage to $8.75 an hour
  • Decriminalize marijuana possession in public view with 15 grams or less
  • Invest $1 billion to preserve affording housing
  • Better combat hunger in the state

Achieve equality for women:

  • Pass a Women’s Equality Act, a 10-point plan to break down discrimination and inequality based on gender
  • Pass the Reproductive Health Act to protect a woman’s right to choose

More to do to protect New Yorkers:

  • Reduce gun violence by putting a safe and fair gun policy in place, including a ban on assault weapons
  • Criminalize the sale and possession of designer synthetic drugs

Strengthen the people’s voice:

  • Make the state’s campaign finance laws more fair, including requiring more disclosure
  • Make voting easier by creating an early voting system
  • Launch OPEN NY to increase government transparency and allow online access to government data, reports, statistics, and other information

Prepare NY for future storms:

  • Harden our infrastructure, including a more resilient New York Harbor, subway system, fuel delivery system and utility infrastructure
  • Update our building codes to improve our buildings’ resistance to storms and provide homeowners in vulnerable locations with support to mitigate future threats or to relocate
  • Redesign our power system to strengthen state oversight over utilities and privatize the Long Island Power Authority’s (LIPA) to address its systemic flaws and weaknesses
  • Establish a world-class emergency response network, including specialized training for the National Guard and the creation of a statewide volunteer network, civilian emergency response corps and private sector emergency response task force
  • Strengthen cell phone networks and communication systems and develop a program to allow mass text messages to send messages to a specific geographic area

Fight climate change:

  • Lower the regional greenhouse gas emissions cap, increase alternative local renewable power sources, and ensure a skilled energy workforce by expanding career training and placement programs

To read his full plan for New York State, click here.

We have proven over the past two years, and will prove again, that New Yorkers can accomplish anything when we work together.
Thank you for all that you do,

The Andrew Cuomo Committee

Implications for Behavioral Health of the U.S. Supreme Court’s Ruling on Affordable Care Act

IMPLICATIONS FOR BEHAVIORAL HEALTH

By upholding the law, this ruling is a great step forward for behavioral health.  It continues the progress intended by Congress through the passage of the ACA.

 

With this definitive ruling, the federal government and states can now move forward with implementation of key features within the ACA that will bring millions of Americans coverage for mental and addictive disorders.  The reform law, now deemed constitutional, starts to expand behavioral  health coverage well beyond the federal parity law.

 

KEY BEHAVIORAL HEALTH FEATURES OF THE ACA

The ACA has been seen as particularly important for behavioral  health because of a number of provisions expanding mental health and addiction treatment coverage to millions of Americans that don’t now have it.  Specifically, the ACA as written in 2010.

 

  • Extends the federal partiy law to small businesses and individuals inside and outside of the health exchanges.
  • Requires – for the first time in federal law – that the essential benefit package include mental health/substance abuse as 1 of 10 required coverage categories.
  • Expands coverage through Medicaid that would need to include that expanded coverage at parity.

 

The ruling also allows other ACA provisions to move forward, including those that:

 

  • Require quality reporting for inpatient psychiatric facilities paid under the IPF PPS
  • Establish a pay-for-performance pilot program for psychiatric hospitals.
  • Reduce the market basket for psychiatric hospitals and incorporate productivity improvements.