Chronic and Complex Populations – Page 21 – The National Academy for State Health Policy

How Governors Addressed Health Care in their 2020 State of the State Addresses

February 13, 2020/in Policy Charts Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health Equity, Health System Costs, Healthy Child Development, Infant Mortality, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Expansion, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Population Health, Prescription Drug Pricing, Social Determinants of Health, State Insurance Marketplaces, State Rx Legislative Action, Work Requirements /by Sarah Lanford and Anita Cardwell

NASHP Joins Lewin Group to Provide Integrated Care for Kids Model Support

February 10, 2020/in Policy Blogs, Featured News Home Behavioral/Mental Health and SUD, Care Coordination, CHIP, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Equity, Health System Costs, Integrated Care for Children, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Physical and Behavioral Health Integration, Population Health, Social Determinants of Health /by Karen VanLandeghem

The Centers for Medicare & Medicaid Services (CMS) has awarded the Lewin Group and its partners, which includes the National Academy for State Health Policy (NASHP), a seven-year contract to support implementation and monitoring for CMS’ Integrated Care for Kids (InCK) Model.

Launched in January 2020, this model is part of CMS’s strategy to fight the opioid crisis and address its impact on vulnerable Medicaid and the Children’s Health Insurance Program (CHIP)-covered children and their caregivers. The InCK Model aims to improve child health, reduce avoidable inpatient stays and out-of-home placement, and create sustainable payment models to coordinate physical and behavioral health care with services to address health-related needs. InCK funding will provide Connecticut, Illinois (2 awards), New Jersey, New York, North Carolina, Ohio, and Oregon with the flexibility to design interventions for their local communities that align health care delivery with child welfare support, educational systems, housing and nutrition services, mobile crisis response services, maternal and child health systems, and other relevant service systems. By bringing together medical, behavioral, and community-based services, InCK strives to reduce fragmentation in service delivery and expand access to care for children and youth.

The Lewin Group, NASHP, and the other team members will support implementation of the InCK Model through technical assistance, program monitoring, measuring awardees’ progress on critical program milestones and outcomes measures, data collection and analysis, and critical feedback loops to support awardees’ work toward their goals.

“The Lewin Group is excited to contribute to this innovative approach that breaks new ground in the delivery of child- and family-centered care and the development of pediatric alternative payment models. We look forward to working with CMS to positively impact of the health of the next generation,” said Lisa Alecxih, Lewin Chief Capabilities Officer.

“NASHP is delighted to partner with the Lewin Group to support this innovative CMS InCK model,” said Trish Riley, NASHP’s executive director. “We bring to this work our decades of expertise in state health care delivery system design, cross-sector partnerships, payment reform, and the unique needs of children and their families.”

The Lewin Group is an established leader in health care and human services policy research, analytics and consulting at the federal and state level.

CMS Requests Input to Better Coordinate Care for Children with Complex Conditions from Out-of-State Providers

February 10, 2020/in Policy Blogs, Featured News Home Children/Youth with Special Health Care Needs, Children/Youth with Special Health Care Needs, CHIP, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, EPSDT, Health Equity, Health System Costs, Integrated Care for Children, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Population Health, Social Determinants of Health /by Kate Honsberger

The Centers for Medicare & Medicaid Services (CMS) recently released a request for information (RFI) for input from states, providers, health systems, and families to better coordinate care from out-of-state providers for children with complex health conditions enrolled in Medicaid. The deadline to submit comments is March 23, 2020.

States have long addressed issues of access to care, provider availability, service delivery system design, and public insurance reimbursement for children with medical complexity (CMC). This RFI addresses considerations for CMC who may require specialized treatment or therapy that is not offered by in-state providers and therefore need services in other states, complicating the ability of states to coordinate and deliver care effectively.

Coordinating care for enrollees from out-of-state providers can also present an administrative burden for state officials who are required to screen and enroll these providers in their Medicaid programs in order to provide payment for services. This RFI is part of a requirement from the Medicaid Services Investment and Accountability Act of 2019 which calls for the secretary of the Department of Health and Human Services to issue guidance to states on this topic.

CMS is seeking input from states and stakeholders who have experience with specific aspects of coordinating care from out-of-state providers, including:

Sate initiatives that have promoted and/or improved the coordination of services and supports provided by out-of-state providers to children with CMC;
Administrative, fiscal, and regulatory barriers that states, providers, and enrollees and their families experience that prevent children with CMC from receiving care, such as community and social support services, from out-of-state providers in a timely fashion, as well as examples of successful approaches to reducing those barriers;
Measures that have been or can be employed by states, providers, health systems, and hospitals to reduce barriers to coordinating care for children with CMC when receiving care from out-of-state providers; and
Best practices for developing appropriate and reasonable contract terms and payment rates for out-of-state providers in both Medicaid fee-for-service and managed care systems.

For a full list of requested information please review the RFI. CMS will review input from states and stakeholders and issue guidance by October 2020. The new guidance will include:

Best practices for using out-of-state providers to provide care to children with CMC;
Coordinating care provided by out-of-state providers to children with CMC, including services provided in emergency and non-emergency situations;
Reducing barriers that prevent children with CMC from receiving care from out-of-state providers in a timely fashion; and
Processes for screening and enrolling out-of-state providers, including efforts to streamline these processes or reduce the burden of these processes on out-of-state providers.

The National Academy for State Health Policy (NASHP) encourages states to submit relevant information to shape future guidance.

The RFI was posted on January 21, 2020 and comments are due March 23, 2020.

View the CMS RFI for instructions on how to submit comments. NASHP will share the release of any future CMS guidance on this topic as part of its ongoing work in the area of children with medical complexity.

To review NASHP resources related to children with medical complexity and children and youth with special health care needs, please visit its resource page.

Federal Funding Change that Includes Stimulants Allows States to Expand their Substance Use Disorder Initiatives

February 3, 2020/in Policy Blogs, Featured News Home Behavioral/Mental Health and SUD, Chronic and Complex Populations, Health Equity, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Population Health, Social Determinants of Health /by Jodi Manz

Since 2017, the federal government has awarded $2 billion to states specifically for opioid prevention, treatment, and recovery. But a new spending package passed last month allows states to use federal funds to address the growing use of stimulants, including cocaine and methamphetamine, that are emerging as the newest wave of drugs fueling the overdose crisis in many states.

The addition of stimulants to federal funding presents both challenges and opportunities for states. They will need to develop initiatives that also address stimulant use, though currently there are few evidence-based treatment guidelines for this. On the plus side, the new funding flexibility allows states to address the social factors that contribute to all substance use disorders (SUD), instead of focusing on a single class of drugs.

Background

To date, federal funding to address the opioid epidemic has flowed from the Substance Abuse and Mental Health Services Administration (SAMHSA) through State Targeted Response (STR) and State Opioid Response (SOR) grants. The latest spending package includes a seemingly minor language addition that poses a potentially major shift in how states use the funding.

What is the fourth wave of the overdose crisis?

Stimulants, including methamphetamine and cocaine, are increasingly prevalent and play a role in overdoses in certain states, mostly west of the Mississippi River.

Prevalence is growing, however, in eastern and Appalachian states already hit hard by opioids as well.

The federal decision to broaden substance categories is a direct response to the quickly-developing threat of stimulants like cocaine and methamphetamine reported in provisional federal overdose data for drug deaths though July 2019. Distinct regional patterns show that stimulants are increasingly prevalent in overdoses primarily west of the Mississippi River, but are growing in eastern and Appalachian states hit hard by opioids. While opioids remain the most frequent killer of Americans who die of drug overdose, the increasing presence of stimulants in this data suggests an emerging “fourth wave” of a drug overdose epidemic that began with prescription opioids and quickly escalated, propelled by heroin and then fentanyl.

Previous iterations of STR and SOR grant funding have given states the opportunity to target funds toward the factors that fueled those waves of opioids. This included prevention initiatives around reducing unnecessary prescribing and diversion of opioids and clinical engagement that was focused on medication-assisted treatment (MAT) for opioid use disorder (OUD). Funds were used to support the development of waivered providers to prescribe buprenorphine, or training for peers with lived opioid experience. The opioid focus was unequivocal.

How States Can Address Stimulant Use

The addition of stimulants to the federal language poses a new set of challenges and welcome opportunities for states. The most pressing issue for both policymakers and clinicians will be treatment – while treatment for OUD can include MAT, often in conjunction with psycho-social supports, treatment for stimulant use currently has no evidence-based medical options, limiting opportunities for clinical intervention to just behavioral mediation.

There is some evidence, however, to suggest that in addition to cognitive-behavioral therapy, contingency management approaches in which individuals are provided with small, tangible rewards for negative urine drug screens can be effective treatment for stimulant use.

Notwithstanding these differences in treatment protocols, states can leverage previous opioid work in their response:

Care models: Integrated care models emphasizing and reimbursing for team-based care can be adapted to these treatment approaches.
Reimbursement: States can use 1115 Demonstration waivers to support financing these models and address the Medicaid Institutions for Mental Diseases (IMD) exclusion to expand inpatient opportunities. (The IMD exclusion prohibits use of Medicaid funds for mental health care provided in residential treatment facilities larger than 16 beds.)
Workforce: States can invest in training and continuing education focusing on stimulant treatment modes for licensed behavioral health providers and non-licensed workforce.

Another major opportunity with this change is that states can explicitly tailor efforts to poly-substance use. Even as opioid overdose deaths have dominated in data reports, media attention, and policy activity in recent years, the majority of opioid overdose deaths reviewed in one recent report from the Centers for Disease Control and Prevention involved at least one other drug. Poly-substance use has been self-reported as near universal by individuals entering treatment specifically for OUD.

States Can Now Address What Fosters All SUD

This federal funding change allows states to use federal grant funds to address the factors that foster SUD, instead of focusing on the effects of a specific substance. For example, given the well-documented link between childhood trauma and SUD, states can invest in prevention efforts that protect children and support resiliency, like reimbursement policies and programs that allow parents with SUD to stay with their children in residential treatment or utilizing models of family-centered treatment. Being mindful of the 2015 study that linked deaths of despair (including those from drug overdose) to economic struggle, states can continue investing in strategies that addressing social determinants of health, including recovery housing, job training, and recovery workplaces.

One of the major challenges of developing state SUD policies is that SUD is not itself substance-specific. This language change aligns federal resources to help states address that discrepancy. Specific state guidance from SAMHSA on this change has not been released, but state policymakers will be able to build on their foundational initiatives developed with the support of earlier federal grants and establish new pathways to innovation.

Transforming Systems to Improve Health Upstream: Lessons from Washington’s Accountable Communities of Health

January 17, 2020/in Policy Washington Blogs, Featured News Home Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Equity, Health System Costs, Healthy Child Development, Maternal, Child, and Adolescent Health, Oral Health, Physical and Behavioral Health Integration, Population Health, Primary Care/Patient-Centered/Health Home, Safety Net Providers and Rural Health, Social Determinants of Health /by Amy Clary

Five years ago, Washington State launched a collaborative regional Accountable Communities of Health (ACH) model to improve the health of communities across the state. These ACHs have evolved into independent organizations that are integral to the state’s health system transformation efforts. A 2019 evaluation by the Center for Community Health and Evaluation found this ACH model has largely succeeded in building robust regional coalitions to improve the health of their communities.

Washington’s ACHs take diverse approaches to improving health through projects such as:

The Pierce County ACH’s Community HUB, which coordinates community health worker services for at-risk pregnant women throughout the county, and
The Olympic Community of Health’s establishment of a regional opiate treatment network.

The ACH projects have aligned with the state’s broader Medicaid transformation effort, which was catalyzed through funding from a four-year State Innovation Models (SIM) test grant.

In their early stages, ACHs prioritized projects designed to improve health-related social and economic conditions. The goals of Washington’s Medicaid transformation demonstration include integrating physical and behavioral health, rewarding outcomes instead of volume in most Medicaid provider payments, addressing the needs of aging populations, and improving health equity.

“A great deal of success locally has been because of the convening role ACHs were able to play. I can’t emphasize enough how important that is in transformation.” – Washington State Medicaid Director MaryAnne Lindeblad

ACH Projects Move Transformation Forward

When Washington’s five-year Section 1115 Medicaid Transformation Project (MTP) was approved in 2017, ACHs designed regional MTP projects that sought to improve clinical care and preventive services while leveraging collaboration across clinical and community organizations to account for social determinants of health. In order to carry out these Delivery System Reform Incentive Payment (DSRIP) projects, ACHs had to build up their organizational infrastructure to the point where they could both develop project plans and distribute the funds to regional partners needed to get the projects off the ground. Given the time-limited nature of these funding sources, sustainability is emerging as a priority for ACHs.

ACHs conduct DSRIP projects on such topics as:

Improving transitional care – when a patient moves from one health care setting to another. The Cascade Pacific Action Alliance is working to coordinate services when patients leave the hospital, in order to improve patient health and reduce preventable hospital utilization.
Improving the integration of physical and behavioral health care. The Spokane region’s ACH, Better Health Together, is working to help patients move between the physical, behavioral, and oral health care systems to receive more integrated care. The evaluation also highlighted the work of the Cascade Pacific Action Alliance, which brings together school districts, physical health clinicians, and behavioral health providers to improve behavioral health coordination for children in the region.
Increasing access to oral health services. North Sound ACH is working to integrate oral health and primary care in community-based settings.

While DSRIP performance accountability focuses primarily on clinical care, the state also encourages ACHs to address health equity, the social determinants of health, and the health of the whole community:

The Greater Columbia ACH created a Community Health Fund with DSRIP dollars to address health-related needs, such as nutrition, transportation, and housing, in its region.
The North Sound ACH requires each MTP partner to participate in an equity and Tribal learning series, and they rotate their meeting locations so that location does not bar any one partner from participating. They also begin each meeting by acknowledging the original inhabitants of the land, according to the evaluation.
The evaluation reported that the HealthierHere ACH established a Community and Consumer Voice Committee, which developed an equity tool to “assess impact and consumer voice.”

Balancing State and Local Roles

As states develop accountable health models that tackle a variety of regional priorities, state agencies often assume the role of key convener for accountable health entities and their local or regional partners. This convening role can help regional entities learn from each other and can inform state approaches so states can balance local or regional goals with broader statewide initiatives.

Just as states convene regional entities, Washington’s ACHs are taking on a critical role in convening their own local partners and supporting efforts to align regional strategies and priorities for much of the state’s health transformation work. The state required ACHs to develop into autonomous nonprofits with the ability to allocate funds and sustain organizational infrastructure. In the process, ACHs have built trusting and collaborative relationships with their regional partners. That successful relationship-building has led to ACHs themselves emerging as key regional players, which effectively positions them to take the lead on other statewide initiatives and activities, according to the evaluation.

As ACHs take the stage regionally, state policymakers are working to balance local expertise with statewide leadership. To allow ACHs to fully capitalize on local and regional knowledge, the state built some flexibility into their structure, such as allowing the ACHs to determine who to include in their governance structures, within state guidelines.

At the same time, the state is responsible for efficiently advancing statewide goals, and certain overarching issues may require a common statewide approach. For example, efficient technology infrastructure or workforce development may call for a statewide solution rather than multiple local approaches. “Consider what would be best served by a statewide coordinated approach to reduce fragmentation, versus a regional approach,” suggested Washington State Health Care Authority Medicaid Transformation Manager Chase Napier.

Conclusion

The recent evaluation of Washington’s ACH model shows the promise of ACHs in moving the state toward health system transformation. While other states’ accountable health models seek to balance local innovation and state coordination, the recent evaluation found that Washington’s ACH model may give states a helpful roadmap for incorporating local and regional voices to improve the health of individuals and communities statewide.

Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.

NASHP’s Top Five Reads of 2019

January 13, 2020/in Policy Blogs, Featured News Home Administrative Actions, Chronic and Complex Populations, Chronic Disease Prevention and Management, Community Health Workers, Health Coverage and Access, Health System Costs, Legislative Tracker, Population Health, Prescription Drug Pricing, State Rx Legislative Action, Work Requirements, Workforce Capacity /by NASHP Staff

Each year, NASHP publishes more than 100 reports and resources to give state leaders the information they need to craft effective legislation and health policies. Below are our most-read resources of 2019.

Rx Legislative Tracker: This resource with its map interface gives you the status of every state’s legislation to curb prescription drug costs since 2015, and it’s updated weekly.
Is it Safe and Cost-Effective to Import Drugs from Canada? NASHP created model legislation for states to use to implement wholesale drug importation from Canada. This infographic explains why it’s safe.
A Snapshot of State Proposals to Implement Medicaid Work Requirements This resource provides descriptions of states’ proposals to implement Medicaid work requirements nationwide.
A Glossary of All Terms Pharma If you want to tackle drug costs, you need to know the pharmaceutical industry’s lingo. This glossary helps demystify pharma’s verbiage.
State Community Health Worker (CHW) Models States are funding, training, and certifying CHWs to help coordinate care, promote access to community services, and address social determinants of health. This resource shows what individual states are doing.

Webinar: Family Caregiving Policies and Innovations

January 13, 2020/in The RAISE Act Family Caregiver Resource and Dissemination Center Webinars Chronic and Complex Populations, Council Meeting Materials and Resources, Long-Term Care, State Resources, The RAISE Family Caregiver Resource and Dissemination Center The RAISE Family Caregiver Resource and Dissemination Center /by NASHP Staff

Family caregivers provide an estimated $470 billion per year in unpaid care and are a critical component for states seeking to support older adults and individuals with complex needs stay in their homes and communities.

Funded by The John A. Hartford Foundation, NASHP’s RAISE Family Caregiver Resource and Dissemination Center hosts a webinar to discuss state and federal policies and initiatives to support family caregivers. The webinar provides an overview of the Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act and features leaders from Tennessee and Washington State who share their policies and innovations to support family caregivers.

Speakers include:

Moderator Wendy Fox-Grage
NASHP Project Director, RAISE Family Caregiver Resource and Dissemination Center

Rani Snyder
Program Vice President, The John A. Hartford Foundation

Greg Link
Director, Office of Supportive and Caregiver Services, US Administration for Community Living

Bea Rector
Director, Home and Community Services Division, Aging and Long-Term Support Administration, Washington State Department of Social and Health Services

Stephanie Gibbs

Director, System Transformation and Innovation, Long-Term Services and Supports, Division of TennCare

Thursday, Feb. 20, 2020
2-3 p.m. (ET)

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Kentucky’s Public-Private Initiative Promotes Employment as a Critical Opioid Recovery Tool

January 6, 2020/in Policy Kentucky Blogs, Featured News Home Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health System Costs, Population Health, Social Determinants of Health /by NASHP Staff

When Beth Kuhn and Kentucky Chamber of Commerce officials meet with employers, their goal is to get them to hire people who are in recovery from opioid use disorder (OUD). “Many people became addicted to painkillers as a result of workplace injuries,” she tells business leaders, “therefore, you share the responsibility to help them in their recovery.”

As chief engagement officer for Kentucky’s Cabinet for Health and Family Services, Kuhn’s job is to help the business community reduce its stigma about opioid addiction and encourage leaders to take a chance on the tens of thousands of Kentuckians who have fallen victim to the state’s devastating opioid tsunami. Employment, and the critical connection to community it engenders, is a critical leg of recovery programs.

In 2017, opioid overdoses killed 1,565 people in Kentucky and the state ranked fourth in the nation for overdose deaths. That same year, Kentucky doctors wrote 86.8 opioid prescriptions for every 100 residents and the state spent so little on treatment that it was ranked the worst in the nation for dollars spent on state substance abuse agencies.

In 2017:

About 68% of injured workers were prescribed opioids – making these painkillers the most prescribed medication in Kentucky’s workers compensation system.
Opioid prescriptions accounted for 20% of the decline in men’s workforce participation and 25% for women.

Appointed by the director of Kentucky’s Office of Drug Control Policy in 2018, Kuhn’s job is to reduce employment barriers and add an essential tool to strengthen the state’s recovery system-of-care programs. Kuhn discussed her program at NASHP’s annual health policy conference in August 2019, and took time to answer questions about how the program moved from “a good idea” to a fully staffed and funded program that works across state agencies and in close partnership with the state’s Chamber of Commerce to encourage employers to join the recovery movement.

Why did Kentucky think it could convince its conservative business community to hire individuals with OUD?

Here in Appalachia, we’re in this epidemic’s epicenter. This has been a wrenching, traumatic issue that has made us open to solutions and big ideas that you may not find in other states. We had pioneering leaders promoting employment and also had providers who were very outspoken in arguing that employment was a critical fourth leg of any treatment program. [The four legs of recovery programs include addressing anxiety, shame, and trauma, and promoting connection.]

And of course, the economy is a driver. Unemployment is low and employers are now willing to consider some people as job candidates whom they wouldn’t have considered when unemployment was at 8 percent. And lastly, we had effective state leaders asking employers, “addiction is a chronic illness, would you turn down a job applicant who had diabetes?”

Which state department is spearheading this?

When this was designed in 2018, we had an alignment of cabinet leaders – justice and public safety, education and workforce development, and health and family services, which I’m a part of. We’re not siloed, we work hand in hand and aggressively partnered to address this crisis. I am leading this as chief engagement officer and my job is to lead policy and operational efforts to better integrate workforce, health, and human service programs.

How was this funded and implemented?

We spent about one year planning, designing, and hiring for the initiative, with funding through September 2020 for 18 employment specialists across the state. Twelve staff are placed in career centers to help employers and job seekers find each other, and we will have six success coaches embedded at employer sites to provide support and resources to individuals to ensure their retention once they are employed or back at work after treatment. Some of our employment specialists work in the state corrections system to link individuals who are being released from jail to the business community. We really worked to do this in a big-picture, comprehensive way.

The program is funded by three sources:

The Kentucky Office of Drug Control Policy/General Funds/Tobacco Settlement provides $1.29 million.
The federal Substance Abuse and Mental Health Services Administration/Kentucky Opioid Response Strategy provides $1.37 million.
And employers have provided about $20,000 to date, for a total program budget of $2.66 million.

The funding from employers is small, but aspirational for us. Part of our model is to place our success coaches in employer sites to help with hiring, training, and supporting workers. Based on past success with a similar national “Employer Resource Network” model, we are confident that funding for those jobs will come from employers.

Who has been your most critical partner?

The Kentucky Chamber of Commerce has been an invaluable partner. The Kentucky Chamber Workforce Center held a statewide opioid summit last summer that they thought would attract 75 to 100 employers, instead they got 300. It speaks to their power as conveners, but this is also a visceral issue in Kentucky with many people out of the workforce because of opioid addiction. With the Kentucky cabinets for Health and Family Services and Justice and Public Safety, the biopharmaceutical company Alkermes, and Aetna, the chamber launched the Opioid Response Program for Business, with members that include Toyota, GE, and Anthem Blue Cross Blue Shield. The program works directly with employers auditing their policies and recommending best practices to maintain a drug-free workplace while supporting a recovery-friendly culture.

How else are you and the chamber making workplaces more friendly to people in recovery?

Some of the things we’ve been discussing with the chamber’s task force. Is how do you change workers compensation and prescribing policies so you’re not part of the problem [about 68 percent of injured workers are prescribed opioids in Kentucky]. Another area is how to change HR policies if a positive drug test occurs in an employee. Historically, the person would be fired, but is that the right way to respond? How about putting that person on medical leave and helping them find treatment? And if someone is in recovery and fails a drug test because of medication-assisted treatment (MAT), what should the response be? In 2019, I think employers are now rethinking whether firing people who fail a random drug test is really appropriate.

To addition to promoting the hiring of people in recovery, Kentucky’s state chamber has endorsed:

-Expanding the number of needle exchange programs beyond the state’s current 45.

-Creating local collaboratives with community and business leaders to discuss the opioid problem and identify innovative solutions.

-Encouraging employment of those in recovery to not only boost workforce participation but to serve as a strong symbol to people with OUD that a productive life beyond drug abuse is possible if they enter treatment.

Another issue is background checks. While some businesses like to be known as second-choice employers, usually it’s for minor offenses, when an applicant fails a background check and it turns out they served time in prison for drug use, often the employer pulls the job offer. Our bigger companies (e.g., Toyota parts suppliers) are now saying they will stop this automatic exclusion if an applicant fails a background check and instead they will review applicants on a case-by-case basis with their attorney and hiring manager. That is what we need when we talk about transformational employment. These discussions can be had by us and the chamber, and they can lead to real change and move that background check needle.

Which employers have been most open to hiring individuals in recovery?

Manufacturers are definitely needy of workers, while construction companies have had a mixed response. On the one hand construction workplace injuries have contributed to a high incidence of illegal drug issues, but on the other hand, many of them get squeamish about hiring people on MAT. Are they safe operating machinery? How we and the chamber respond is, “well you let people with diabetes use the equipment, why not people in recovery?”

The health care industry is tricky, there are some licensing issues around drug offenses and employees’ access to drugs. But phlebotomists, for example, have no access to drugs, some of these restrictions are worth reviewing by state policymakers.

What remains the biggest barrier to employing people in recovery?

I think fear and some inaccuracies employers hold about MAT, but stigma remains the biggest barrier. That is why encouraging partnerships between business organizations is so important. It’s hard for me if I’m from the state or a nonprofit to make that argument, we’re the do-gooders. The chamber is in a different a position, they have the ability to make that argument very effectively.

RAISE Family Caregiving Advisory Council Requests Input for Report

December 16, 2019/in The RAISE Act Family Caregiver Resource and Dissemination Center Blogs, Featured News Home Council Meeting Materials and Resources, The RAISE Family Caregiver Resource and Dissemination Center /by NASHP Staff

The Administration for Community Living is requesting information from individuals and organizations to assist the RAISE Family Caregiving Advisory Council in developing goals, objectives and recommendations for an initial report to Congress and national family caregiving strategy, which are required by the RAISE Family Caregivers Act of 2017. The input will also help the council plan public listening sessions. To submit comments, click here. The deadline to submit recommendations is Feb. 7, 2020.

Virginia Advances Integrated Care for Pregnant and Parenting Women with Substance Use Disorder

December 16, 2019/in Medicaid Managed Care Virginia Blogs, Featured News Home Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Infant Mortality, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Population Health, Special Populations and Services /by Melissa Caminiti and Ashley Harrell

To tackle the opioid epidemic, which has been the leading cause of unnatural deaths since 2013, Virginia recently developed an integrated physical and behavioral health continuum of care, which spans multiple treatment settings and includes case management and peer recovery support. The initiative, combined with increased access to naloxone and other efforts, has helped reduce fatal overdoses by 3.3 percent between 2017 and 2018.

In March 2016, with support from Virginia Gov. Terry McAuliffe, the Virginia General Assembly passed appropriations mandating transformation of the SUD Medicaid benefit entitled the Addiction and Recovery Treatment Services program or ARTS, which was implemented on April 1, 2017. Early results from Virginia’s ARTS program indicate success in increasing access to care for Medicaid-eligible pregnant women with SUD and opioid use disorder (OUD).

Data obtained from pre-ARTS implementation (covering April 2016-March 2017) compared to post-ARTS implementation (April 2017-March 2018) indicate that the percent of Medicaid-enrolled pregnant women with SUD who received treatment increased from 2 percent to 21 percent, while the rate of pregnant women with OUD who received treatment increased from 4 percent to 31 percent. In addition to increasing treatment rates, the number and types of treatment providers and treatment programs available to pregnant women with SUD and OUD also increased significantly in the post-ARTS implementation period.

Ashley Harrell, senior program advisor with Virginia’s Department of Medical Assistance Services (DMAS), recently shared the goals and highlights of the program with the Maternal and Child Health Policy Innovation Program (MCH PIP) Policy Academy, hosted by the National Academy for State Health Policy (NASHP). The academy, made up of eight cross-sector state teams, focuses on the mental health needs of pregnant and parenting women, particularly those with or at risk of substance use disorder (SUD). The ARTS program has six major goals:

Expand the short-term SUD inpatient detox benefit to all Medicaid/FAMIS enrollees (FAMIS is Virginia’s health insurance program for uninsured children);
Expand short-term SUD residential treatment to all Medicaid enrollees;
Increase reimbursement for existing Medicaid/FAMIS SUD treatment services;
Add peer support services for individuals with SUD and/or mental health conditions;
Require SUD care coordinators for DMAS-contracted managed care plans; and
Organize provider education, training, and recruitment activities.

The Virginia state Medicaid agency has made additional policy changes to improve access to care for pregnant enrollees with SUD. Some of these changes include:

Allowing and encouraging same-day billing of medical and behavioral health services;
Requiring access to medication-assisted treatment (MAT) along the addiction care continuum; and
Removal of prior authorization requirements for up to 24 mg/day of Suboxone film for in-network buprenorphine-waivered practitioners.

Additionally, the Virginia Medicaid MEDALLION 4.0 has an embedded High-Risk Maternity Program that includes comprehensive care management and family planning services to women with SUD. MEDALLION 4.0 is a statewide, fully capitated, risk-based, mandatory managed care program for Medicaid and Family Access to Medical Insurance Security (FAMIS) members that operates under the authority of a §1915(b) waiver. MEDALLION 4.0 covers pregnant women, infants and children and provides acute and primary health care services, prescription drug coverage, and behavioral health services for their members.

Harrell’s presentation spurred much discussion among academy participants, who quickly shared their concerns about access to care, integration of services, health equity, and the long-term health outcomes of women, children, and families affected by SUD.

Over the next two years, NASHP academy participants will continue to learn from each other and from subject matter policy experts as they strive to develop, support, and advance state-level policy innovations for pregnant and parenting women with or at risk for SUD and/or mental health conditions. Understanding state innovations is key to identifying new strategies to leverage change. As one policy academy participant observed during the meeting, “No one [state] has all the answers, but we have a lot of resources in each other.”

For more information on the academy, read NASHP’s blog, New Eight-State Policy Academy Advances Access to Care for Pregnant/Parenting Women with SUD. For more information about the Virginia ARTS program, visit the Virginia DMAS ARTS website or email questions about the ARTS program to sud@dmas.virginia.gov.

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