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

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)

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.

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 (2007-2016), 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

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) - 300 to 691 practitioners Treating SUD - 667 to 1,603 practitioners Effective April 1, 2017 Addiction and Recovery Treatment Services (ARTS) Peer Recovery Supports effective July 1, 2017

Key Findings First Five Months of ARTS Implementation Treatment rates increased by 50 percent Treating Opioid Use Disorder (OUD) - 300 to 691 practitioners Treating SUD - 667 to 1,603 practitioners Data from DMAS

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

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

18 CSBs Receive FY 2018 Same Day Access Funding

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 3-3.5 hours to 1.5-2 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, 2017. From Dec. 1 – Dec. 29, there were 81 people who walked in for services.

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)

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

Questions?

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 (gena.berger@governor.Virginia.gov) 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

HHr Team Gena Berger, Deputy Secretary gena.berger@governor.Virginia.gov Marvin Figueroa, Deputy Secretary marvin.figueroa@governor.virginia.gov Jodi Manz, Assistant Secretary (Jodi.manz@governor.virginia.gov Massey Whorley, Senior Policy Advisor massey.whorley@governor.virginia.gov Jennifer Bean, Executive Assistant: Jennifer.bean@governor.virginia.gov