Special Commission to Investigate and Study State Licensed Addiction Treatment Centers

Special Commission to Investigate and Study State Licensed Addiction Treatment Centers Meeting Minutes Friday, October 28, 2016 3:00pm – 5:00pm One Ashburton Place, Boston, MA 02108

Commission Members Present: Secretary Sudders Scott Taberner Kevin Wicker Emily Stewart Joanne Peterson Dr. Henry East-Trou Marcy Julian Doris Kraemer Joshua L. Giles

Other Attendees: Jonna Hopwood Michael Kelleher Summary of Discussion: Meeting Convened Welcome / Vote to open up conference line Secretary Sudders moved to open up the conference line. The motion was approved and the line was opened. Review of September 19 meeting minutes Secretary Sudders moved to accept the September 19 meeting minutes as presented. The motion was approved and the September 19 meeting minutes were approved. Review draft Report to General Secretary Sudders reviewed the charges of the Special Commission: The special commission to investigate and study state licensed addiction treatment centers was established by section 60 of chapter 52 of the acts of 2016. The Commission’s charge was to: 1. Solicit information and input from addiction treatment service providers, consumers, families and any other parties or entities the commission considers appropriate; 2. Examine the effectiveness of addiction treatment services in promoting successful outcomes of recovery and wellness; 3. Examine ways to encourage engagement from individuals in recovery from substance use disorders in policy development related to service delivery and the training and evaluation of services; 4. Consider best practice models of delivery and the provision of recovery oriented services in other states; 5. Examine mental health considerations when an individual enters an addiction treatment center, including, but not limited to, patient access to mental health services; 6. Recommend legislation to improve services for people in a state licensed addiction treatment center; and 7. Submit a report to the general court of the results of its investigation and its recommendations, if any, not later than January 1, 2017 Secretary Sudders pointed Commission members to the summary of Commission findings (page 3 of the PPT) Secretary Sudders stated the Commission must produce tangible recommendations to the legislature and produce suggested legislation. While the Commission's report is not due until January 1, 2017 if we want the legislature to consider our recommendations we should submit them before the holidays. Representatives and Senators will be looking for ideas for legislation prior to the holidays, so they are ready to file bills by the filing deadline in mid-January for the new legislative session. Marcy Julian provided a brief update on the Hampden County Sheriff’s Department Treatment Model, particularly the role of MAT options and interventions taking place within the model. Scott Taberner stated the finding of a siloed mental health system is a major issue across the system and across multiple conversations. It is something the 1115 Waiver will seek to address. Scott Taberner continued to state that there are multiple references to making sure the patient gets to the right level of treatment at the right time which is consistent with the authority requested in the new 1115 waiver. Scott Taberner need to connect/integrate residential services within ancillary mental health services; promote models that do this well. Again, the waiver authority could go a long way in accomplishing this. Dr. Henry East-Trou stated the “stigma” finding and recommendation should be broadened as stigma is a “two-way street.” Dr. East-Trou suggested the following language for a recommendation to address this: “Anti-stigma interventions should target the review of eligibility criteria, policies and procedures associated with approval/denial of services that may unintentionally enhance the experience of stigma and delay vital necessary treatment.” Emily Stewart stated there are particular communities and neighborhoods where stigma is particularly relevant. Is there a way to focus the efforts to destigmatize SUD treatment within these neighborhoods? Emily Stewart continued we need to expand education efforts within these specific neighborhoods, particularly schools, community centers and other community resources. By helping to support the building the necessary support systems in those communities hardest hit by these issues, we can begin to empower a dialogue within these communities.

Dr. Henry East-Trou stated these efforts must be embedded into the fabric of the community; there are lots of religious institutions that should be included. Many people who need help are afraid – due to stigmatism – to approach their pastors or rabbis – but this can be addressed. Emily Stewart stated the finding regarding increased access to Recovery Coaches needs to be expanded to include the support, training and supervision of Recovery Coaches. Also, need to be clear how we are defining Recovery Coaches as they are doing more than they used do/what people think they do. As they are asked to take on more responsibility, we need to provide more support, training and supervision. All: Should there be a Recovery Coach Academy or RC certification process? (i.e., required training, observation or standards) Emily Stewart stated the Commonwealth should provide technical assistance and training to Treatment Providers that supports direct engagement of community stakeholders in culturally-relevant and trauma- informed anti-stigma education including families and other allies, neighborhood associations, faith-based organizations, area businesses, schools, local government, local law enforcement and criminal justice officials and other local institutions. Emily Stewart stated, specifically, we need to include trauma-informed peer-support groups for PRCs working with individuals at high risk for relapse and overdose. The Secretary moved the discussion to the Commission Recommendation section of the presentation. Scott Taberner stated the sharing of “best practices” needs to ensure we are looking across all types of modalities. Scott Taberner stated he is supportive of the recommendation to complete a comprehensive assessment for all patients but that all is depended on which comprehensive assessment is utilized, what information it captures and how this information is used. Emily Stewart stated, regarding the MAT recommendation, we need to provide better information on what MAT is, how it works, why MAT should be a treatment pursued by consumers. Need better tools to support informed decision making. Dr. Henry East-Trou stated SUD providers should have agreements or partnerships with multiple MAT treatment centers. Consumers need multiple options when it comes to MAT treatment centers as options for them. Emily Stewart stated, regarding co-occurring SUD and mental health concerns, the Commonwealth needs to do a better job at connecting the two worlds via training and education. Scott Taberner stated this can be accomplished via the 1115 waiver currently being negotiated with CMS. Dr. Henry East-Trou stated we should consider the potential of co-licensing staff in multiple scopes of practice. Emily Stewart stated we need to develop and document a formal system of transportation and communication to support the effective transfer of medication across levels of care, to ensure continuity of care for individuals in need of MAT, psychopharmacy, or who are living with other chronic medical conditions. Emily Stewart continued, we should include a recommendation to address barriers and challenges to ensuring medications are part of the transition protocols. Dr. Henry East-Trou added, post-transition is a particularly difficult time and often patients are unable to see their primary care physician in a reasonable time post program release. Secretary Sudders stated we need to expand upon the pioneering set of medical education core competencies for the prevention and management of prescription drug misuse agreed to by medical schools, dental schools, nursing school and social workers to include schools of psychiatry and clinical mental heath. Dr. Henry East-Trou stated the review and promotion of “best practices” should also include payer-led interventions and programs. Dr. East-Trou continued to state that there are a lot of providers who do not have solid protocols in place and don’t know how to assess and transfer patients who need SUD treatment. It is the time period after release when people are most at-risk for relapsing. Emily Stewart stated it is very important to have the necessary protocols in place to make sure a person is stepped down from addiction treatment to a less intense setting without a relapse. Doris Kraemer stated addiction is a life-long disease and people require ongoing services, observations and connections. Somehow providers need to be aware of where folks are in the recovery process. There needs to be a constant awareness of the pathway folks are on along the trajectory of recovery. Dr. Henry East-Trou stated there is significant opportunity for the collection and review of quality of program data that will be useful for the Commission in the long-term. Doris Kraemer stated we need to be able to capture data regarding the positive outcomes of these programs and it sounds like the new waiver authority would be helpful in accomplishing this. Secretary Sudders stated we should not be so specific in terms of which data we will be able to collect and make public until we get a handle on what data is available. Doris Kraemer stated Medicare requires a certain level of regional data by level of treatment. We should review what data is required by Medicare. It is a good model of a data comparison tool.’ Doris Kraemer stated currently, Medicare requires DPH to perform an annual compliance assessment of all Medicare certified/licensed facilities across the state. This information is then submitted to CMS so that CMS is able to produce a quality rating for all certified/licensed skilled nursing facilities across the country. The data is uniform and evaluates facilities on licensing requirements from a federal and state level.

Review of Substance Abuse Provider Practice Analysis Report (SAPPA) Secretary Sudders stated a discussion was had at the last Commission meeting regarding data collected by the State; particularly what types of analytics are able to be conducted. Scott Taberner introduced Jonna Hopwood, MBHP’s Director of Substance Treatment Services to provide us with an overview of the Substance Abuse Provider Practice Analysis Report (SAPPA) s the Massachusetts Behavioral Health Partnership (MBHP) provides on where members are going, demographics and member disposition. Scott and Jonna provided the overview of the data collection process as part of the Substance Abuse Provider Practice Analysis Report The data source for the SAPPA is claims submitted into MMIS by MBHP providers. The data is useful in determining which level of care the patient enters but has some challenges in following the patient as they transition to other (less acute) levels of care. For example, if the patient goes somewhere that isn’t captured in claims, they won’t be included in the report. Also, the data cannot differentiate patients who drop out of care versus patients who get lost in the system – but are not intending to drop out of addiction care. Jonna Hopwood pointed out that these reports are subject to other limitations of claims-based data including claims lag and claim submission errors. Jonna Hopwood stated this system provides a dashboard for providers. Part of the reporting component acts as a claim-based intervention and engagement. In other words, MBPH has developed logic to measure how effective a provider is in engaging patients into treatment. For example, for patient with a newly diagnosed or SUD treatment claim, the analysis will do periodic “look backs” to gauge whether there are additional claims for this patient that would indicate a trajectory of SUD care. The same data limitations, specific to claims submission and analysis, are factors in the accuracy and timeliness of these reports. One thing this report can be used for is to identify which providers need additional information, training and support. Scott Taberner stated by setting it up as a provider dashboard, MBPH may be able to update the data more rapidly, not in real-time, but in sufficient time where a provider could be better equipped at following up on their patients who require it. Scott continued, one of the major benefits of this approach is to be able to track the member’s journey through the system. Dr. Henry East-Trou asked if we could review what data is required to be collected for accreditation. This data could be useful since it is, in theory, regularly reported. Dr. Henry East-Trou asked it were possible to gain access to the dashboard beyond a provider’s own data. What data, in aggregate is available to review and analyze? Jonna Hopwood stated that the Outpatient Practice Pattern Report could be a resource to answer some of the Commission’s questions. Emily Stewart stated we need to be careful about how much data we ask for. Reporting data is an onerous task, it is very expensive (staff resources and systems). Therefore, we should align new data needs with data already collected and allow data entered in multiple systems to be shared. Next steps for draft Report Secretary Sudders asked for Commission members to submit any suggested changes or edits to Michael Kelleher by Thursday, November 17, 2016. This was the last meeting of the Special Commission. No additional meetings will be scheduled. Meeting Adjourned.