News & Notes

Policy brief outlines strategies to promote employment among people with psychiatric disabilities: UMass Medical School and the Bazelon Center for Mental Health Law have released a publication describing national and state policies that can be leveraged to forge a strong foundation for providing employment services to people with psychiatric disabilities. The brief focuses on opportunities created by the Affordable Care Act (ACA), the Americans with Disabilities Act, the Workforce Innovation and Opportunity Act, regulatory changes to Medicaid home- and community-based services and to Section 503 of the Rehabilitation Act, state-based Employment First initiatives, and proposed reforms to Social Security benefits. For example, the ACA requires that both Medicaid expansion and marketplace health plans cover ten essential benefits, including rehabilitation services, such as physical and occupational therapy. The authors of the Kaiser brief call on the Center for Medicare and Medicaid Services to more fully clarify that parity rules apply to the rehabilitation services benefit and that psychiatric rehabilitation services, including supported employment, should be covered to the same degree as physical rehabilitation services. In addition, the ACA has made it easier for state Medicaid programs to cover supported employment services by expanding and strengthening Medicaid’s 1915(i) State Plan option. Since 2007, states have had the option of providing limited employment services under the 1915(i) option. Under the ACA, states can now use the 1915(i) option to provide more comprehensive employment services and can target them to specific groups, such as people with psychiatric disabilities. Currently, 12 states have active 1915(i) options, and four more are planning to apply for the option, according to research cited in the report. However, only one state has used the option to include supported employment services as a benefit. As awareness grows about the “reach” of this option, the authors note, it is likely that more states will leverage it to provide critical employment services. Policy Opportunities for Promoting Employment for People With Psychiatric Disabilities concludes with several recommendations to address barriers to employment. The 14-page brief is available on the Bazelon Center’s Web site (http://www.bazelon.org/LinkClick.aspx?fileticket=ISpjUu3smuQ%3d&tabid=794).

Enhanced residential crisis stabilization units for Medicare-Medicaid enrollees: An issue brief rom the Integrated Care Resource Center (ICRC) describes an alternative to inpatient psychiatric care for the under-65 Medicare-Medicaid population. Individuals in this dually enrolled population, many of whom have serious mental illnesses, are among the most costly enrollees in both programs. Commonwealth Care Alliance, a not-for-profit health plan in Massachusetts, has created a new setting of care—an enhanced residential crisis stabilization unit (enhanced CSU)—to fill a gap in the behavioral health continuum of care. The goal of enhanced CSUs is to decrease the use of high-cost Medicare inpatient psychiatric hospitalizations and emergency department admissions by enrollees who are experiencing a psychiatric crisis and who could be appropriately cared for in a community-based crisis stabilization setting. The ICRC brief describes the development of CSUs and key features of the model. It also includes preliminary findings on the impact of the enhanced CSUs and considerations for other states or health plans that may want to develop a similar care setting. The 12-page brief, Alternatives to Inpatient Psychiatric Services for Medicare-Medicaid Enrollees: A Case Study of Commonwealth Care Alliance, is available on the ICRC Web site (http://www.integratedcareresourcecenter.com/PDFs/ICRC_CCA_Case_Study%20(002).pdf).

Free training in medication-assisted treatment for opioid use disorders: Physicians who wish to obtain a waiver to prescribe and dispense buprenorphine for treating opioid use disorders are required to take eight hours of training. The Substance Abuse and Mental Health Services Administration, in collaboration with the Health Resources and Services Administration, is offering this training free of charge. Training is provided through the Providers' Clinical Support System for Medication Assisted Treatment (PCSS-MAT), which uses a “half-and-half” format: 3.75 hours of self-guided online training and 4.25 hours of classroom-style training with an instructor, either in person or via a live webinar. Registration for the two-part training is available on the PCSS-MAT Web site (http://pcssmat.org/education-training/waiver-eligibility-training), where physicians who have already completed the eight-hour waiver training can access a free one-hour review course.

NIDA creates online resource to raise awareness about naloxone: In 2014, nearly 19,000 Americans died from an opioid analgesic overdose, and more than 10,500 died from a heroin-related overdose. Responding to public demand for tools and information to help stem the growing opioid overdose epidemic, the National Institute on Drug Abuse (NIDA) has created a Web section (https://www.drugabuse.gov/drugs-abuse/opioids/naloxone) that provides resources about naloxone, the opioid overdose reversal drug. The need for public information about naloxone has increased because of two recent FDA approvals of naloxone products—prepackaged nasal spray and auto-inject formulations—that are easier for laypersons to use. The NIDA resources include information about naloxone, how and by whom it can be given, and where to obtain it. Dosage information, precautions, and the side effects of naloxone are also provided. The NIDA Web section also includes links to pharmacies that offer naloxone (with and without a prescription) and links to related federal and private-sector Web sites.

Kaiser brief describes initiative in three states to connect justice-involved persons to Medicaid: Three states—Arizona, Connecticut, and Massachusetts—are leading efforts to help ensure that eligible individuals scheduled for release from incarceration are enrolled in Medicaid in order to obtain needed health and mental health care in the community. A new issue brief from the Kaiser Family Foundation describes initiatives in these states. The brief is based on telephone interviews conducted in early 2016 with a range of stakeholders, including staff from Medicaid agencies and state Departments of Corrections and Justice Departments, providers and health plans, and advocates. In addition to prerelease Medicaid enrollment, the three states are connecting individuals with Medicaid coverage by suspending (rather than terminating) Medicaid eligibility when a person enters jail or prison, enrolling incarcerated individuals into Medicaid when they receive inpatient care that qualifies for coverage, and enrolling individuals in other areas of the justice system, including those on probation and parole. In Connecticut and Massachusetts, a majority of the incarcerated population is enrolled in Medicaid on release. Arizona reaches a smaller share of the incarcerated population because it targets efforts to those with serious mental illness and complex general medical conditions; however, the state has plans to broaden its scope. Stakeholders in all three states cited similar barriers. The jail population is difficult to reach because many move quickly in and out of custody. Because of system limitations in their Medicaid programs, all three states rely on paper applications for prerelease enrollment. Stakeholders noted that obtaining health care is only one of many competing priorities for newly released individuals. They stressed the importance of “meeting people where they are” to address their other priority needs, such as housing, food, and employment. The 14-page issue brief is available on the Kaiser Foundation Web site (http://kff.org/medicaid).

NASHP brief examines efforts to promote “accountable communities for health”: To achieve the Triple Aim objectives of improved care, lower health care costs, and better health, many states are partnering with local communities to implement population health initiatives that engage community partners in addressing the social determinants of health, such as housing, food, work, and community life. Among these community-based models, “accountable communities for health” (ACHs) are emerging as a promising strategy to align a state’s efforts to transform health care delivery with community-based social services to create communities that promote health and well-being. A new brief from the National Academy for State Health Policy (NASHP) identifies “levers” that states can use to promote ACHs in local communities. Although communities drive ACHs, states can play a critical role in their development, sustainability, and scope by developing a framework for ACH implementation that integrates with other aspects of the delivery system and by supporting local innovation. The brief examines efforts in four states—California, Minnesota, Vermont, and Washington State—and weighs the roles that states and communities have played in establishing core ACH components, including governance structures, geographic boundaries, financing mechanisms, priority conditions and target populations. The brief also considers state-level resources that can be leveraged to support and sustain ACH models. The 22-page brief, State Levers to Advance Accountable Communities for Health, along with detailed profiles of efforts in the four states, is available on the NASHP Web site (http://nashp.org/state-levers-to-advance-accountable-communities-for-health/).