1. Secretary of Health and Human Resources Daniel Carey, M.D.
House HWI Committee
Secretary of Health and Human Resources Daniel Carey, M.D.
January 2018

2. Secretary of health and Human Resources
Daniel Carey, MD
Graduated from the University of Virginia and Harvard Medical School.
Internship and Residency at the University of California, San Francisco
Cardiology Fellowship and a Fellowship in Interventional Cardiology at Emory University.
Practice in Lynchburg since 1997
Served as Medical Director of the Centra Stroobants Heart Center at Lynchburg General Hospital, and President of the Lynchburg Academy of Medicine, the Medical Society of Virginia and the MSV Foundation.
Previously President/Chief Physician Executive of Centra Medical Group (CMG)

3. 2017 3nd quarter - All Opioids
This is the most recent data from OCME. 3rd quarter data is expected later this month. This is all opioids, both Rx and fentanyl/heroin.

4. Opioid approach 1,100 Virginians died of an opioid overdose in 2016
Driven by illicit synthetic opioids
Team approach
Keys are prevention and treatment
Fatal drug overdose has been the leading method of unnatural death in Virginia since 2013, and the leading method of accidental death since 2014
Opioids have been the driving force behind the large increases in fatal overdoses since 2013
Starting in 2015 and continuing since, illicit opioids deaths surpassed prescription opioid deaths.
No significant change in fatal prescription opioid overdoses over the 10 year time span ( ), but fatal fentanyl overdoses increased by 176 percent from 2015 to 2016.
Rural areas of Virginia have the highest mortality rates due to prescription opioids, while urban areas have the highest mortality rates due to illicit opioids like heroin and fentanyl

5. Addiction recovery treatment services
ARTS
Inpatient Detox
Residential Treatment
Partial Hospitalization
Intensive Outpatient Programs
Opioid Treatment Program
Office-Based Opioid Treatment
Case Management
Peer Recovery Supports
All Community-Based SUD Services will be Covered by Managed Care Plans
A fully integrated Physical and Behavioral Health Continuum of Care
In 2015 close to 70% of members were served in managed care. With the implementation of MLTSS, this will close to 90% served in managed care.
To fully integrate physical and behavioral health services for individuals with SUD and expand access to the full continuum of services, DMAS plans to “carve in” non-traditional SUD services into Managed Care for members who are already enrolled in plans. The only service currently covered by managed care is inpatient detoxification.
Non-traditional services that will be “carved in” include Residential Treatment, Opioid Treatment (medication and counseling component), Substance Abuse Day Treatment, Crisis Intervention, Intensive Outpatient Treatment, and Substance Abuse Case Management.
Magellan will continue to cover these services for those Medicaid members who are enrolled in FFS
Effective April 1, 2017 except for Peer Supports which will be effective July 1, 2017.
Providers will need to become enrolled and credentialed with the managed care plans beginning 4/1/17. Majority of members are covered by managed care and most when the Managed Long Term Services and Supports (MLTSS) is implemented.
Treatment rates among Medicaid members with substance use disorders (SUD) increased by 50%
The number of practitioners providing outpatient psychotherapy or counseling to Medicaid members more than doubled:
Treating Opioid Use Disorder (OUD) to 691 practitioners
Treating SUD to 1,603 practitioners
Effective April 1, 2017
Addiction and Recovery Treatment Services (ARTS)
Peer Recovery Supports effective July 1, 2017

6. Key Findings First Five Months of ARTS Implementation
Treatment rates increased by 50 percent
Treating Opioid Use Disorder (OUD) to 691 practitioners
Treating SUD to 1,603 practitioners
Data from DMAS

7. Increases in Addiction Providers Due to ARTS
More than 350 new addiction treatment provider organizations in Medicaid.
Addiction Provider Type
# of Providers before ARTS
# of Providers after ARTS
% Increase in Providers
Inpatient Detox (ASAM 4.0)
Unknown
103
NEW
Residential Treatment (ASAM 3.1, 3.3, 3.5, 3.7) 4 78
↑ 1850%
Partial Hospitalization Program (ASAM 2.5) 13
Intensive Outpatient Program (ASAM 2.1) 49 72
↑ 47%
Opioid Treatment Program 6 29
↑ 383%
Office-Based Opioid Treatment Provider 55

8. System Transformation, Excellence and Performance in Virginia (STEP-VA)

9. 18 CSBs Receive FY 2018 Same Day Access Funding

10. Sampling of Same Day Access Initial Results
CSB
Initial Results for Same Day Access
Chesterfield
Eliminated wait-lists. Has zero no-shows for assessments (means staff spend less time doing outreach and rescheduling people who do not follow through with services). Improved (lower) drop-out rates from assessment to admission.
Blue Ridge
Decreased intake time from hours to hours.
Henrico
Engagement improved with a substantial increase in the show rate to the program (2016: 56% show rate; 2017: 77% show rate). Large increase in clients entering into services compared to 2016.
New River Valley
Wait time for initial intake has gone from almost 4-6 weeks to 0 days; No show rate for first appointment from assessment has decreased from over 40% to 18%.
Hanover
Launched December 1, From Dec. 1 – Dec. 29, there were 81 people who walked in for services.

11. STEP-VA services Same Day Access Primary Care Screening & Monitoring
Behavioral Health Crisis Services
Outpatient Behavioral Health
Psychiatric Rehabilitation
Peer/Family Support Services
Veterans Behavioral Health
Care Coordination
Targeted Case Management (Adults and Children)

12. Enhanced federal match in virginia
Additional coverage would make ARTS benefit available to more people
Enhanced federal match funds would support $200 - $300 million annually for treatment of mental health and addiction
Untreated mental illness costs hospitals, law enforcement, and governments
Virginia could have more robust system if we accepted federal dollars to help pay for behavioral health services

13. Questions?

14. HHR Deputies Marvin Figueroa (marvin.figueroa@governor.virginia.gov)
Agencies:
Department of Medical Assistance Services
Department of Behavioral Health and Developmental Services
Department of Aging and Rehabilitative Services
Department for the Blind and Visually Impaired
Department for the Deaf and Hard of Hearing
Department of Health Professions
Gena Berger
Department of Health
Department of Social Services
Virginia Foundation for Healthy Youth
Virginia Board for People with Disabilities
Office of Children’s Services
Assistive Technology Loan Fund Authority

15. HHr Team
Gena Berger, Deputy Secretary Marvin Figueroa, Deputy Secretary Jodi Manz, Assistant Secretary Massey Whorley, Senior Policy Advisor Jennifer Bean, Executive Assistant: