January 15, 2021
Proposal: Promote Integrated Addiction and Mental Health Care through Streamlined Licensing
Since taking office, Governor Cuomo has emphasized the interrelationship of addiction, mental health, and physical health, and recognized the benefits of integrating health care services. The Governor directed the Office of Mental Health (OMH), Office of Addiction Services and Supports (OASAS), and Department of Health (DOH) to work collaboratively with each other and with providers to integrate those providers’ delivery of substance use disorder, mental health, and physical health services. More than 100 clinics now operate under Integrated Outpatient Services (IOS) licenses, allowing for more comprehensive, consistent, and informed treatment and streamlining oversight and administrative burdens. These efforts have provided better opportunities for individuals receiving treatment for substance use disorder or mental health to obtain basic primary care.
Integrated care is particularly valuable for the significant number of individuals with co-occurring substance use and mental health disorders. In the OASAS system, 50 percent of individuals admitted for non-crisis substance use disorder treatment had a co-occurring mental health disorder.26 Similarly, in 2018, 20 percent of the individuals who received a Medicaid mental health service, more than 100,000 people, also received substance use disorder services.27
While the Governor’s Medicaid Redesign Team and other policy reforms have provided New York with a solid foundation to support access to and quality of addiction and mental health services, the integrated treatment of substance use disorder and mental health disorders has not yet been fully realized. Despite the reduction of regulatory burdens due to the Governor’s actions, many service providers continue to operate programs licensed by both OMH and OASAS, and many providers have not been able to integrate programs successfully. These dual systems of care require providers and counties to follow two distinct sets of rules and regulations, require State agencies to utilize two sets of staff to monitor and fund providers, and require patients to attend services at two programs that often do not collaborate on issues of patient care.
To better support the significant number of people with co-occurring disorders, and to create important government efficiencies, the Governor will propose legislation to enable outpatient providers to more easily integrate physical health care with addiction and mental health services. Current structures include varying, even conflicting, requirements regarding physical plant, workforce, billing, and acceptance for admission. Currently, and without this new licensure opportunity, an individual suffering from both mental health issues and addiction would be forced to address whichever illness was deemed primary or attend two separate providers to meet their needs. After this new single license, a provider would be able to serve the mental health, addiction, and primary care needs of any patient regardless of their “principal diagnosis,” finally achieving the goal of having “no wrong door.” The proposed legislation will establish a single license authorizing the licensee to provide a full array of physical, addiction, and mental health services.
Proposal. Continue Innovation in Opioid Treatment
To combat the opioid epidemic, Governor Cuomo has expanded access to medication assisted treatment, mobile treatment, peer support services, and drug user health hubs. These initiatives have decreased the rate of opioid overdoses and opioid-related hospitalizations and emergency department visits. Between 2016 and 2019 there was a 42 percent decrease in opioid overdose deaths in counties that participated in State Targeted Response grant activities. Those that participated in year two experienced a 64 percent decrease in opioid overdoses. More than 3,700 people obtained medication-assisted treatment and 11,870 people received opioid overdose reversal training.
Even with all of these reforms, many people who would benefit from medication-assisted treatment do not receive it, due in significant part to strict federal regulation against anti-addiction medication. Further, many providers remain entrenched in a treatment philosophy that requires patients to report to opioid treatment programs (OTPs) daily for medication administration. This outmoded requirement can restrict patients’ ability to work or attend school, and for some necessitates a difficult choice between seeking treatment or meeting other obligations. These issues have left communities across the state with significant gaps in access to addiction treatment and have resulted in some individuals not receiving the care they need.
The pandemic has pushed the system of treatment for opioid use disorder to quickly adapt and respond better to patient needs. OTP patients were able to obtain take-home medications more frequently or for longer durations, and where patients were isolated due to the pandemic the OTP provided delivery of medications so that patients would not endanger their recovery. OTPs were also able to expand services and support patients unfamiliar with take-home medication by engaging them in telehealth services, including by telephone only, which was previously not permitted. Governor Cuomo will direct the Office of Addiction Services and Supports to build on the improvements made during the pandemic by:
· Increasing the availability of Medication Assisted Treatment resources across the state by
increasing the number of co-located medication units and mobile addiction treatment programs;
· Expanding the use of take home medication for opioid misuse;
· Providing immediate help by allowing OTPs to provide interim maintenance treatment to those
seeking treatment, thereby eliminating waitlists at opioid treatment programs;
· Increasing peer and family services in OTP settings to make programs more patient centered;
and
· Incorporating outpatient rehabilitation services into OTPs for those in need of more intensive
services.
Proposal: Protecting New Yorkers with Addiction and their Families from Predatory Practices
The opioid crisis has increased demand for effective addiction treatment services. In response, Governor Cuomo has directed State agencies to collaborate with insurers and providers to direct individuals and families to reputable, quality programs. At the same time, families desperate to save a loved one have become vulnerable to unscrupulous individuals and businesses marketing shoddy and discredited treatment programs, offering services they are unqualified to provide, and making effectiveness claims they know are unwarranted.
To prevent predatory practices, Governor Cuomo signed legislation in 2018 prohibiting New York treatment programs from using “patient brokers.”
Out-of-state addiction treatment providers, however, have continued to send marketers to speak at community gatherings, provide school presentations, and attend self-help and family meetings. In some instances, marketers have disseminated misleading or false information about the programs they recommend, or have failed to disclose their own connection to those programs. In addition, there have been reports of individuals purporting to act as “sober coaches,” “life coaches,” and “recovery coaches” without any certification, license, or credential, and without any genuine knowledge of addiction or treatment.
To reinforce and strengthen the prohibition on patient brokering, Governor Cuomo will direct the Office of Addiction Services and Supports (OASAS) to develop an authorization process and standards for individuals and businesses who assist New Yorkers in finding treatment. These standards will require “marketers” to clearly disclose their connection to any treatment program, clearly explain their fee structure, and prohibit misrepresentations about service quality, efficacy, or structure. OASAS will develop and make public a trusted list of individuals and businesses that families can rely on for assistance. This will ensure that anyone who is advertising as an expert and assists people in finding services cannot charge a fee without registering with OASAS and following regulatory standards set by the state.