Cuomo Focus: MH/SU Services for Homeless, Opioid Epidemic, 1,000 Days on Medicaid; Telehealth

NYAPRS Note: Here are excerpts from Governor Cuomo’s just concluded State of the State presentation of a number of items of interest to our community. NYAPRS greatly appreciates the Governor’s strong commitments to further address homelessness, the opioid epidemic, early health intervention and prevention strategies and telehealth expansion in rural communities. 
In a few weeks, we also hope to see Executive Budget proposals that address a number of our top priorities for the coming session, including housing rate and workforce pay hikes and criminal justice and adult home reforms. 
Please start now to prepare to join hundreds of peers and colleagues at NYAPRS February 27thLegislative Day!

Increase Mental Health and Substance Use Disorder Services for Individuals Experiencing Homelessness

Two of the primary contributing factors to homelessness, especially for homeless single adults, are mental illness and/or substance abuse. We know that 20-25 percent of those experiencing homelessness in the United States suffer from substance use disorder or severe mental illness and New York State is in line with national statistics in this area. Accessing treatment and recovery services, even when an individual is willing to accept them, is often difficult.
To strengthen shelter services for homeless individuals living with mental illness in existing homeless shelters, Governor Cuomo will direct the Office of Mental Health and the Office of Temporary and Disability Assistance to work together to ensure that Assertive Community Treatment teams are connected to existing shelters, so that individuals with mental illness can access needed treatment.
In addition, the Office of Alcoholism and Substance Abuse Services will make on-site peer-delivered substance abuse treatment services available in 14 existing shelters across the state. These on-site services will serve close to 200 homeless individuals with substance use disorder, with services provided in shelters that are located in areas that have seen the biggest increases in substance use.

Addressing Homelessness

Governor Cuomo will direct the Office of Temporary Disability Assistance to require social services districts to engage in planning activities related to street outreach, homelessness prevention activities, rapid rehousing, and ongoing housing stability for the formerly homeless. The State will require the social services districts to engage with ongoing efforts, set reasonable goals that are data-driven and uniquely tailored to the needs of its communities, and to report regularly on progress made. The State will provide technical assistance throughout the planning process by releasing guidance related to best practices and policies that can facilitate success.
To strengthen shelter services for homeless individuals living with mental illness in existing homeless shelters, Governor Cuomo will direct the Office of Mental Health and the Office of Temporary and Disability Assistance to work together to ensure that Assertive Community Treatment teams are connected to existing shelters, so that individuals with mental illness can access needed treatment.
In addition, the Office of Alcoholism and Substance Abuse Services will make on-site peer-delivered substance abuse treatment services available in 14 existing shelters across the state. These on-site services will serve close to 200 homeless individuals with substance use disorder, with services provided in shelters that are located in areas that have seen the biggest increases in substance use.

New York State Mentoring Program

Approximately 13,000 students, over six percent, still drop out of high school every year. The drop-out rate is even higher for Students with Disabilities and English Language Learners. Mentoring is recognized as a dropout prevention strategy by the United States Department of Education.

A study of more than 14,000 adolescents found that youth with an adult mentor were twice as likely to attend college as their peers. Yet only half of youth in poverty report having an adult mentor. Research has found that youth with mentors were less likely to break the law or experience substance abuse. Mentors make a difference in helping students of all backgrounds succeed. A separate study found that girls that engaged in a supportive mentoring relationship were four times less likely to participate in bullying behaviors than girls without mentors.

 

First 1,000 Days on Medicaid

Because nearly 60 percent of all children ages zero to three in New York are covered by Medicaid, the State’s Department of Health (DOH) is uniquely positioned to address the health needs of children and families as well as the social determinants impacting their health.
In August of 2017, Governor Cuomo directed DOH to create a First 1,000 Days on Medicaid working group to identify and recommend ways to improve outcomes and opportunities for young children and their families through access to childhood health services and expansion of other health and early childhood system coordination and family supports. The working group, co-chaired by former SUNY Chancellor Nancy Zimpher and State Education Department Commissioner Mary Ellen Elia, intentionally adopted a cross-sector strategy to include participation from more than 200 members representing stakeholder interests from the health and mental health, education, early childhood, and child and family sectors. The working group developed a set of ten recommendations that are evidence-based and measurable to drive outcomes for young children and their families through improving childhood health services, expanding programs that work, and investing in family supports to focus on enhancing access to services and improving outcomes for children during their first 1,000 days of life.
Based on the recommendations of the working group, Governor Cuomo will begin implementation of the comprehensive First 1,000 Days Plan to:

· Develop a clear, standardized model of pediatric primary care to ensure that growth and development are on track and establish a uniform measurement tool for providers and educators to assess child development upon kindergarten entry. Aligned with the American Academy of Pediatrics’ standard of care, DOH, in collaboration with a Preventative Pediatric Clinical Advisory Group, will develop a framework model for providers serving families with children ages zero to three on how best to organize well-child visits, which will include standards for the use of care coordination and protocols, the selection and timing of early childhood screening tools, incorporating trauma-informed care into practice, developing systems to receive follow-up after screening and referral to offsite programs, and delivering culturally and linguistically appropriate care.
Facilitate group-based models of prenatal care to support pregnant women living in neighborhoods with the poorest birth outcomes in the State, including high incidence of preterm births and low birth weights.
· Enhance home visiting services in three high-risk communities using a targeted approach to match families to a home visiting program that best fits their needs and eligibility.
· Launch peer-family navigator services in non-healthcare community settings, such as family homeless shelters and drug treatment centers, to facilitate effective warm handoffs from the provider diagnosing the child to the treatment provider allowing continuity of care in services for at-risk families.
· Provide parents of young children with improved access to evidence based parent-child therapy models.

Reverse the Opioid Epidemic

Under Governor Cuomo’s direction, New York has taken bold steps in confronting the local effects of a nationwide crisis of deadly addiction to opioids, with significant increases in treatment capacity, strong support services, the removal of barriers to accessing high quality treatment, and public awareness and education activities. In 2016, Governor Cuomo signed into law a comprehensive plan following the recommendations of the Heroin and Opioid Task Force to increase access to treatment, expand community prevention strategies, and limit the over-prescription of opioids in New York. The following year, Governor Cuomo’s budget dedicated more than $200 million to support education, prevention, and treatment and recovery programs targeted toward combating opioid addiction.

Despite our progress, far too many New Yorkers continue to suffer the consequences of addiction. In fact, the latest data indicates that more than twice as many people in New York died from opioid-related causes than in motor vehicle accidents deaths. To address this public health emergency, Governor Cuomo is proposing a comprehensive five-point plan to build on New York’s role as the national leader in combating addiction.

· First, to hold pharmaceutical companies accountable for their role in perpetuating the opioid epidemic, the Governor with the New York Attorney General will take enforcement actions against pharmaceutical opioid distributors for breaching their legal duties to monitor, detect and report suspicious orders of prescription opioids. The three largest wholesale distributors in the U.S.—with combined annual revenues of $400 billion—control 85 percent of the market for prescription opioids and have violated their duty by selling large amounts of painkillers that were then diverted for illicit uses, helping to contribute to the opioid epidemic. 65 Any funds received from such enforcement activity would be used to support the state’s efforts to combat opioid addiction.
· Second, the Governor will strengthen protections against addiction stemming from prescription opioids. Governor Cuomo has championed legislation limiting opioid prescriptions to seven days and requiring providers to consult the prescription drug monitoring database when prescribing opioids, which have become national models for reform. To further protect New Yorkers from addiction, the Governor will advance legislation to restrict subsequent fills to no more than one additional seven-day prescription of opioids for acute pain without having an in-person visit with the prescriber to evaluate alternative pain management therapies. The Governor will also advance legislation that authorizes the Department of Health (DOH) to apply the same limitations to patients with a diagnosis of chronic pain who have not previously used opioids and to require Emergency Department prescribers to also consult the Prescription Drug Monitoring Program before prescribing opioids. DOH and the Office of Alcoholism and Substance Abuse Services (OASAS) will create a Statewide Pain Management Steering Committee bringing together clinical experts to make recommendations on pain management issues, taking into account the latest Centers for Disease Control and Prevention guidelines.
· Third, the Governor will take steps to eliminate insurance barriers to addiction treatment and recovery services by limiting requirements for prior authorization and co-payments for outpatient addiction treatment. The Governor will also direct the new Statewide Pain Management Committee to make recommendations related to coverage of alternative pain management treatments.
· Fourth, in conjunction with eliminating insurance barriers to treatment, Governor Cuomo will also direct several State agencies to implement regulatory and policy reforms that increase access to substance use disorder services. These reforms may include consideration of new regulations to include subacute pain as a qualifying condition for medical marijuana. The Governor proposes the creation of 250 Certified Peer Recovery Advocates to assist our efforts to engage New Yorkers in seeking treatment and sustaining their recovery after treatment. Recovery Peer Advocates are people who have been impacted by addiction who use their unique life experience to help others. Relevant agencies will also coordinate and expand their efforts to harness data and share information to mobilize more rapid and comprehensive responses to drug overdoses.
· Fifth, recognizing the increasing role of fentanyl analogs in drug overdose deaths, the Governor will advance legislation to add 11 fentanyl analogs to Schedule I of the controlled substance schedules of New York State Public Health Law. To combat the rising threats and health risks of other synthetic drugs like K2 and Spice, the Governor is also advancing legislation to add 35 different synthetic cannabinoids to New York’s schedule of controlled substances and give the New York State Health Commissioner the authority to add to the state controlled substances schedule any new drugs that have been added to the federal schedule. In so doing, Governor Cuomo will be empowering state and local law enforcement to use their investigative and prosecutorial tools to crack down on dealers and aid in efforts to prevent the spread of deadly new drugs as they emerge.

Together, the Governor’s reforms will dramatically increase the effectiveness and efficiency of our addiction services and continue to build on New York’s role as the national leader in combatting addiction.

Telehealth

Many rural New Yorkers still face the challenges of long travel distances and provider shortages, which can present substantial costs and barriers to care. Telehealth can be an important and effective tool in bridging the access gap,68 yet health care providers in rural areas face resource constraints across programs, impeding their ability to make the investments necessary to support innovative programs like telehealth and expand access to care within their communities.
To continue to build on the State’s historic progress in increasing access to health care, New York State will take a series of steps to modernize the delivery of telehealth services and ensure that rural New Yorkers have access to the care they need, when and where they need it.
First, New York State will propose legislation to ensure that New Yorkers covered under the Medicaid program can receive telehealth services in a wider range of settings—including from their own homes. Under current state law, outdated statutory barriers restrict the settings in which patients can access telehealth services—meaning patients looking to receive care may still need to travel long distances in order to be eligible for these services and may not be able to receive telehealth services where and when they need them most. Under new legislation, a patient may receive telehealth services wherever they are located.
The State will also launch a new pilot program to address the resource constraints that many rural health care providers face. The pilot will support rural providers across the State of New York—enabling them to make the necessary investments in telemedicine equipment and IT support to bring health care to rural New York.