January 26, 2024

ACTION ALERT:  Urge Congress to Move the SUPPORT Act Forward!

Mental Health America’s youth leaders are asking you to tell Congress to enact the SUPPORT Act with four provisions that can help advance youth peer support. You can find the link to the action alert, a graphic to promote, and language you can use or adapt here. Please share far and wide, as each submission matters and success is all about the numbers!

ALERT LINK: https://mhanational.salsalabs.org/youthpeersupportactionalert/index.html

Here’s the background

The SUPPORT Act has the potential to create monumental changes for peer support nationwide as it includes language to 1) create grants for peer-to-peer programs in high schools, 2) reauthorize a federal peer support technical assistance center, 3) collect vital data on youth peer services in Medicaid, and 4) codify the Office of Recovery at SAMHSA to promote lived experience.

Despite the youth mental health crisis being at an all-time high, many young people are forced to go without needed support. Young people deserve access to high-quality, community-based peer support services, with the SUPPORT Act providing a key opportunity to finally answer the unmet needs of youth nationwide.

Mental health is a bipartisan issue, with youth across the nation leading advocacy efforts to demand peer support services that would save the lives of their friends, classmates, and community members. We are asking you to not let them down.

Please join Mental Health America in sending a letter to your U.S. Senators and House Representatives to ensure youth peer support policies are quickly passed as part of the SUPPORT Act.

ALERT LINK: https://mhanational.salsalabs.org/youthpeersupportactionalert/index.html

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In upstate NY, opioid addiction treatment gets harder to find

25 Jan 2024 SPENCER NORRIS, NY Focus

In late June, the state’s commissioner for addiction services, Chinazo Cunningham, stood in front of a packed ballroom of care providers. There was a map of New York on a projector screen, covered in blue splotches. Those blobs, she assured the room, would help get methadone to people in treatment for opioid addiction.

Each blob was supposed to show a two-hour driving radius for the state’s new fleet of mobile medication units – effectively methadone clinics on wheels, operated by healthcare contractors. On paper, it’s a simple proposal: Bring the medication to patients who can’t get it. The state would fund up to 35 units, Cunningham told the room, eliminating a vast treatment desert that spans most of the state.

The commissioner was optimistic. So was her boss. In her State of the State book, Hochul touted “several” vans that had hit the streets, delivering the medication to New Yorkers who struggled to get access.

But those 35 vans wouldn’t materialize. In reality, 11 were planned. And two years after the state proposed them, only two are in operation – both in New York City.

Upstate New Yorkers are more likely to die from an opioid overdose than people living in the city. They’re admitted to emergency departments for overdoses 31% more often per capita than people in the five boroughs, and they’re prescribed opioids more than twice as often.

Although it’s one of the oldest, methadone remains often the best treatment option for patients with severe addictions – and it has become increasingly necessary as the drug supply has become both more addictive and more lethal. While the state’s plan lags, more and more New Yorkers have struggled to get one of the gold standards for opioid treatment.

A New York Focus analysis of treatment data from the state’s Office of Addiction Services and Supports found that methadone is incredibly difficult to access in most of the state. In huge swaths of upstate New York, it’s almost entirely unavailable.

New York Focus found:

¯ The average New Yorker has to travel at least 9.6 miles to reach the nearest clinic offering methadone on site. When New York City is excluded, the distance is 15.1 miles.

¯ That distance is growing every year. Since 2018, the average distance traveled has increased by more than three and a half miles – a 60% hike over five years.

¯ Even as overdoses spike, fewer people than ever are getting access to treatment in New York. Admissions to opioid treatment programs were at their peak in 2007, at 14,326. By 2021, the latest year for which data is available, that number declined to 11,609 – a 19% drop, and a close second to the lowest number in 14 years.

¯ Just 34 of New York’s 62 counties have an opioid treatment program site.

¯ The vast majority of opioid treatment capacity – 68% – is concentrated in New York City, even though 57% of New York state residents live outside the five boroughs. Although the city covers just over half a percent of the state’s total land area, it accounts for more than half of all locations that offer methadone on site.

¯ As a result, people outside the city have to travel nearly three times further on average to reach an opioid treatment program.

Experts reviewing New York Focus’s findings expressed dismay about the significance of the disparity.

“It becomes an issue of privilege and access the minute that you see a map like this,” said Megan French-Marcelin, senior director for New York State policy at Legal Action Center.

For many people who live upstate, the distances can be crushing. They don’t have the same robust public transportation system as patients in New York City, and they often don’t have a car. This can make the average nine and a half miles virtually impossible to cover – and at least 1,150 people admitted to treatment programs had to travel twice that distance to reach a treatment program. If they’re lucky, they might have a bus that will take them near the clinic or be able to take a cab paid for by Medicaid, but the commutes can still take hours out of their daily lives.

In many cases, experts have pushed buprenorphine as a solution in rural areas. It isn’t as strictly regulated, and it’s well-suited to combat heroin addiction. But with fentanyl in circulation, more physicians are realizing that buprenorphine isn’t a one-size-fits-all solution. Some clinicians have suggested that current dosing guidelines for buprenorphine aren’t sufficient to control cravings for the more potent synthetic opioid. And in some cases, people on buprenorphine run a higher risk of going into severe withdrawal than those taking methadone.

Methadone, French-Marcelin said, “is a solution that’s readily available, scientifically tested, and considered a gold standard of medication.” But the state is “not enabling people to use that in a safe and effective way.”

In a statement to New York Focus, OASAS spokesperson Evan Frost wrote that “Medication for addiction treatment, including methadone, has been proven to be safe and effective, and reduce overdose deaths by as much as 50%. OASAS continues to work closely with our providers to increase access to this medication across the state.”

Frost could not provide more information when asked about the discrepancy between Cunningham’s public remarks and the state’s plans.

According to the vision Cunningham presented last summer, the vans will help patients by eliminating at least some of their daily commute. But a hypothetically simple task – outfitting a cargo van with a locking refrigerator and delivering medication – is massively complicated by a tangle of state and federal regulations.

“It’s not a mystery,” said Dr. Noa Krawczyk, a professor of population health at New York University’s Grossman School of Medicine, “We know very well why there’s gaps in these areas.” In her view, federal policies on methadone distribution are the largest impediments to access in rural areas like upstate New York.

From 2007 to 2021, the federal Drug Enforcement Agency maintained a moratorium on mobile units, citing concerns about safety and medication diversion. When pandemic-era restrictions put many methadone clinics out of reach, the DEA announced a rule change to allow new mobile units. A few months later, OASAS issued a request for proposals for providers to begin rolling out the vans, hopeful that they would be able to bridge the gaps in methadone access.

There was a major catch. Under federal rules, the vans can only be run by preexisting brick-and-mortar opioid treatment programs – which are rare in upstate New York.

Opioid treatment programs are difficult to start in rural areas. Providers have to recruit trained staff, develop a large enough client base to be financially viable, and potentially defeat local opposition. As a result, some rural counties with high overdose death rates also have disproportionately little capacity in treatment programs. New York City, where the two operational methadone vans are located, does not have these problems for the most part (though some local advocates have pushed to reduce the number of methadone programs in Harlem).

To get the client bases they need, some of the methadone vans will likely target population-dense areas instead of the hard-to-reach corners of the state that Cunningham pointed to during her presentation. One of the first upstate methadone vans is expected to hit the road in March. Run by Cayuga Addiction Recovery Services, it will travel from their facility in Ithaca to Norwich with two stops: the county jail, and a parking lot in the latter city.

“I think it was a smart choice for that program to kind of figure out where people need the access here in our community,” said Allegra Schorr, President of the Coalition of Medication-Assisted Treatment Providers and Advocates of New York State. “I don’t know that they have a plan to go much further away.”

Even if the economics work out, the rat’s nest of paperwork, bureaucracy, and inspections can set back the rollout for a new van by months. VIP Services, which operates one of the two city-based vans, reported that its unit was sitting, waiting to be used, from July to November.

Pressure is mounting on Hochul to expand treatment upstate and to get overdoses under control. As the governor pushes her priorities for the state budget, observers will be looking for new tactics to connect people with medication-assisted treatment – and for any evidence that the mobile medication units are being rolled out.

“We’ve all seen lives in every corner of the state sapped by opioid dependence,” Hochul said during her State of the State address, promising to expand access to naloxone and fentanyl test strips. She made no mention of methadone or other medication-assisted treatments.

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A KENNEDY ON K STREET: 

Former Rhode Island Democratic Rep. Patrick Kennedy has a new gig on K Street, where he’s tapping his passion for mental health and addiction policy to launch a new practice focused on those issues at the health-focused consulting and lobbying firm Healthsperien.

Kennedy is joining the firm as a partner and will register to lobby on issues related to community-based health care services and transforming the health care system broadly in addition to mental health and addiction policy.

Kennedy, who authored the 2008 law requiring insurers to cover mental health on the same terms as physical health, told our Ruth Reader that he’s aiming to bring together labor unions, insurers and the government to address shortages in the mental health workforce — which insurers have pegged as a roadblock to offering parity in mental health coverage, earning the industry a rebuke from the Biden administration last year. “What I’ve really wanted to do is create an AFL-CIO for addiction,” he told Ruth, adding that Congress can help with “an infrastructure bill” for mental health.\

Since leaving office amid his own public mental health struggles, Kennedy co-founded and leads a nonprofit focused on mental health policy advocacy, but to this point had not formally registered as a lobbyist. He said in a statement provided by the firm that he’s eager to “re-engage with my colleagues on Capitol Hill to advance our longstanding bipartisan commitment to high-quality, community-based mental health and addiction care.” (Source: Politico)

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Telehealth bill kickstarts year of debate

On Wednesday, Sens. Bill Cassidy, M.D. (R-LA), Tina Smith (D-MN), John Thune (R-SD), and Ben Cardin (D-MD) introduced a rejiggered version of the  Telemental Health Care Access Act floated last year. If passed, the bill would eliminate the requirement that Medicare enrollees be seen in person for an initial visit within six months of receiving mental health treatment over telehealth. While telehealth access to behavioral health care is now permanent, the in-person requirement will be reinstated at the end of this year.

The bill highlights how many of the pandemic-era regulatory flexibilities designed to streamline access to virtual care are on borrowed time. They were temporarily extended at the end of the official public health emergency but will expire at the end of 2024 if Congress does not move to either extend them again or make them permanent. Strap in, it’s gonna be a wild ride. (Source:  STAT News)

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Community Care of Brooklyn (CCB), a network of more than 1,000 Brooklyn-based providers and community-based organizations, has teamed up with Unite Us to track and reimburse for social services.

The pilot will use Unite Us’ payments solution to track services and reimburse participating community-based organizations (CBOs). Through the pilot, CBOs are paid when working with qualifying individuals experiencing food insecurity, inadequate or unstable housing or difficulties navigating social services. 

This marks the first time a payment infrastructure is added to the network’s referral service, known as CCB Navigator. It uses a custom needs assessment screening tool and the Unite Us platform, which offers closed-loop referrals between providers and CBOs, to connect patients to social services. 

“We recognize that our network is really only as good as the CBOs that we have to refer to,” Danielle Cuyuch, CCB’s operations lead, told Fierce Healthcare. These organizations are “really struggling,” she added, and CCB wanted to support them.

The coordinated care network was originally launched in 2022 as a partnership between Maimonides Medical Center, Brooklyn’s largest hospital, and the Brooklyn Health Home. The latter is a Maimonides-managed entity that provides community-based care management services to individuals living with multiple chronic illnesses, as well as Unite Us.

CCB has received a grant that is funding the payments pilot, Cuyuch said. Once a CBO gets a referral from the network, it accepts it in the Unite Us platform, which then generates an invoice that gets sent back to the funder—in this case, CCB—for payment.

“It seems like something that would be very simple, but it’s infrastructure that a lot of CBOs don’t have,” Cuyuch said.

The pilot launches on the heels of the newly approved 1115 Medicaid waiver amendment in New York. The waiver aims to build a more resilient and integrated delivery system while addressing health-related social needs. It also calls on the development of social care networks—entities contracted in each region of the state to provide social needs screening and referral services. 

Social determinants of health determine up to 80% of a person’s health outcomes. CBOs have long struggled nationwide with chronic underfunding, but stakeholders in New York hope that the new waiver will offer a more sustainable funding source for their work. The waiver is expected to be released around August, per Cuyuch.

Unite Us offers training for CBOs on how to use its platform and monitors its networks to ensure active use, Cuyuch said. CCB also reviews this data to help stay on top of referrals. Since launching with Unite Us in 2022, about 360 closed-loop referrals have been made on the platform through CCB, according to Cuyuch. The payments pilot will run through 2024. (Source:  Fierce Healthcare)