NCPA Executive Director Report

NCPA Executive Director Report

June 25, 2016

Mission #1 Promote the Highest Quality of Care

Medicaid Reform

NCPA was represented at many of the public forums held by DHHS to gather input before submitting the Medicaid Reform waiver to CMS. The plan was submitted to CMS on June 1, meeting the legislative deadline. Hours before the submission, DHHS Secretary Rick Brajer presented the plan to the legislature, commenting that the physician community was very vocal and very concerned, particularly about access for patients and about administrative barriers. There was much reassurance that the lessons learned from the mental health transition to managed care would be heeded. There was also much talk that the plan would include the integration of physical and mental health.

NCPA submitted comments to DHHS in April; there is also a period for public comment to CMS. NCPA will submit its comments to the federal agency.

ED Boarding

NCPA continues to participate in two sets of meetings that are designed to craft solutions to the ED Boarding issue that NCPA has championed. The NC Hospital Association Behavioral Health Work Group held one of its three meetings on the topic in May, which I participated in. The NCPA “White Paper” on Boarding that was developed by the NCPA Task Force and submitted to the Governor’s Task Force on MH/SA is frequently referred to in these meetings. Dr Burt Johnson and I also participate in a monthly meeting with leadership from Triangle area hospitals to work on this issue.

HB2

As discussed at the April Executive Council meeting, an ad hoc group made up of Drs. John Kraus, Keith McCoy, Brad Reddick and Amba Jonnalagadda met with NCPA staff and lobbyist to develop a position on the recently enacted legislation. Executive Council voted on the statement, it was delivered to legislative leadership, made public, and posted not only on the NCPA website, but was picked up by other state and national groups.

Legislative Activity NCPA is Monitoring and Engaging On

·  Consolidation of licensing boards (an effort to eliminate “unnecessary regulation of professions” (and allow internet sites such as Yelp and Angie's List to protect the public). Some provisions include consolidating substance use professionals under the LPC board and eliminating podiatry licensure.

·  Funding for the LME/MCOs

·  Expansion of first commitment exams to LPCs and Marriage & Family Therapists

·  Gun legislation

·  Minors consent for treatment

Mentally Ill in Jails

For the past four years, NCPA has met regularly with leadership in the Department of Public Safety and Central Prison Mental Health Hospital to advocate for improved medical care, appropriate screenings and treatment, and suspension of segregation (“solitary confinement”) for inmates with mental illness. Our meetings have been elevated to Deputy Commissioner of Public Safety and the Director of Prisons. We continue to advocate for adequate psychiatric staffing and psychiatric medical leadership at the highest levels. Our efforts resulted in Dr. Jeff Metzner being hired to evaluated the system both in 2012 and 2014, and with the Department receive a federal VERA grant for technical assistance in reducing segregation. This month, Commissioner Guice announced the elimination of segregation for youths aged 16-18, a real step forward for our effort. DPS is currently without a psychiatric medical director, and I met privately with the Director of Prisons George Solomon this month to discuss our concerns and why this must be corrected.

In addition to the work with NC DPS, I have had the personal/professional privilege to assist with a national APA effort here in North Carolina. The Stepping Up Initiative is funded by the APA Foundation, the National Association of Counties, and the Council of State Governments Justice Center. It is a county effort to create local collaborations to reduce the number of people with mental illness in jails. I serve as a sub-committee chair for Alamance County. Our country was one of 200 counties that applied to attend the national Stepping Up Summit in April, and one of only 50 chosen. I was part of the 5-person team to attend, along with our county manager, a county commissioner, the chief deputy Sheriff, and the director of DSS. It was a shining moment for the APA and its partners, and I was pleased to be able to introduce my NC team to APA President Rene Binder, CEO Saul Levin, retiring Foundation CEO Paul Burke, and numerous APA board members and staff. It was a great event. I am now working with NCDMHDDSAS justice staffer Bob Kurtz to promote the Stepping Up effort in North Carolina. Support for Stepping Up was recommended in the report of the Governor’s Task Force on Mental Health and Substance Use, and a group of leaders across the state are working to plan a statewide Stepping Up Summit, possibly as early as August. The APA Foundation and the Council of State Governments seem interested in our effort to translate the national effort into a state initiative.

Network Adequacy

NCPA and our Joint Insurance Committee have been working for the past two years on the issue of network adequacy—whether insurance company panels have an adequate number of psychiatrists and mental health professionals and whether the NC Department of Insurance (DOI) has stringent enough standards to ensure patients with mental illness have access to appropriate professionals. We had a series of meetings with DOI staff in 2013, 2014 and 2015 to discuss the DOI standard, and in the fall of 2015 handed this project to a group of UNC Public Health students to study data submitted to DOI from insurers. The December 2015 report states that insurance companies are inconsistent in their reporting and in their results. The APA has also identified network adequacy as a major problem that results from the lack of mental health parity provisions, from low rates paid to providers, and from administrative burdens such a prior authorizations.

With strong encouragement from NCPA and JIC, NC DOI has established work groups that will be meeting this summer and fall to identify provisions NC should include in adapting model legislation recently released by the National Association of Insurance Commissioners. The goal is that NC DOI will prepare a bill to be considered during the 2017 long session. Dr. Marvin Swartz is attending the DOI workgroup meetings with me, and we are conferring with the APA on ideas that should be included in a North Carolina bill. The idea is that ultimately, insurers will be responsible for contracting with enough psychiatrists to meet the need for our state’s population, which may—in turn—require insurers to offer more favorable contract terms.

Mission #2 Advance and Represent the Profession of Psychiatry in NC

White Coat Wednesday May 11

Laura Willing and lobbyist Christopher Hollis planned NCPA’s annual White Coat Wednesday. More than 20 psychiatrists--many residents and fellows—attended the event and held multiple meetings with state representatives and senators. The primary goal for these events is to position psychiatry and psychiatrists as the medical experts on mental health care and to help build relations between members and the association with elected officials. We were grateful current and future Executive Council members Samina Aziz, Laura Willing, PG Shelton and Winfield Tan participated.

Mission #3 Serve the Professional Needs of Members

Medicaid Credentialing Problems

NCPA staff has been working for a number of months to assist members who are having difficulty getting recredentialed in Medicaid with NCTracks. When members contact NCPA directly, we have been able to assist in expediting these problems. While it is an assist to our members, most importantly it prevents patients from being unable to get their medications as prescribed.

Medicaid Payment Issues-Suboxone

A couple of members have contacted the NCPA office about not getting payments from NC Medicaid for patients they treat with suboxone. Again, we contacted DMA staff to research the issue and learned that there was a coding change in January and that payments have been delayed. We will continue to monitor this situation, since the coding change will have another impact at the end of June.

Operations/Staffing/APA Updates

Staffing

As acknowledged at last Executive Council meeting, Kristin Milam left NCPA in April for the NC League of Municipalities. I have not pushed quickly for a replacement: Katy Kranze and I are in the process of reassessing our needs internally before moving forward. I also want to meet with the Budget Committee as we determine our next steps.

Katy Kranze is doing exceptional work in the NCPA office—trying out new assignments and tackling new responsibilities—while at the same time, making progress on planning for the Annual Meeting. She attended the APA Annual Meeting and DB Executive Director sessions in May, was able to join our Assembly Reps Sunday morning to accept the Assembly Best Practice Honorable Mention award. I am grateful for her professionalism, loyalty, and work ethic these last couple of busy months.

Annual Meeting

Annual Meeting promotion and registration is underway. The meeting will take place September 8-11 at the Asheville Renaissance Hotel. Speakers include: Michael Thase, Pierre Blier, Helen Mayberg, Scott Leibowitz, Stephen Wyatt, Eric Morse, Sy Saeed, and others. We are also hosting the APA 6-hour Collaborative Care training during our meeting, and trying to organize a high-level Collaborative Care Model meeting to bring together these national experts with leaders in DHHS, primary care, health systems, and insurers. We are well ahead of where we were last year at this time with promised sponsorships and exhibits. Please let NCPA staff know of possible companies and vendors who should be contacted about our exhibit hall opportunities. We want our vendors at the meeting to be companies of interest to psychiatrists!

APA

NCPA submitted an application for an APA “Expedited” Grant; the amount awarded will be determined by the number of DBs who apply for this grant. Our application is to update our member database, with a special focus on members who do not have an email address on file, have opted out of NCPA communications, participate in our Find a Doctor directory, and who have not logged into our database since 2012. We just received the notice from the APA for the competitive grant application process due next month. We are not certain if we have the resources currently to apply for or manage the extra work required for this grant.

55 NCPA members were honored at the Convocation of Fellows at the APA Annual Meeting

APA has announced new head of Government Relations (Ariel Gonzales), interim director of Communications (Glen O’Neal), new Executive Director for the APA Foundation (Daniel Gillison), and announced that long-time director of membership Susan Kuper has taken a position with another association.

Other

The June print newsletter (produced by Katy) will be mailed out this week.

Membership: we currently have 898 members and are working to reinstate the 39 members who dropped in March