DHSS Receives Medicaid Substance Use Disorder Waiver from Federal Government

DHSS Secretary Dr. Kara Odom Walker says, “In the midst of the opioid crisis we are facing in Delaware and across the country, (these facilities) are another resource we can use to better serve our Medicaid clients in need of treatment for substance use disorder.”

NEW CASTLE (Aug. 5, 2019) – The Department of Health and Social Services received approval recently from the Centers for Medicare and Medicaid Services (CMS) for a waiver amendment allowing DHSS to use federal Medicaid funding for addiction-related treatment of individuals in substance use disorder (SUD) treatment facilities known as IMDs.

Delaware was the 25th state to receive approval of the SUD waiver by CMS. Previously, federal Medicaid funds could not be used to pay for addiction-related services at IMDs (institutions for mental disease) for individuals ages 21 to 64. Before the waiver, Delaware’s Medicaid program used state funds to pay for addiction-related services provided to Medicaid clients at IMDs. There are four IMDs in Delaware that provide addiction-related services: SUN Behavioral Delaware near Georgetown; Dover Behavioral Health in Dover; MeadowWood Behavioral Health near New Castle; and Rockford Center near Newark.

The IMD exclusion, which prohibits the use of federal Medicaid funds for care provided to most patients in mental health and substance use disorder residential treatment facilities with more than 16 beds, had been part of Medicaid since its enactment in 1965. Delaware’s waiver applies only to addiction-related services for Medicaid clients.

“We are grateful to CMS for granting us this waiver,” said DHSS Secretary Dr. Kara Odom Walker, a practicing family physician. “In the midst of the opioid crisis we are facing in Delaware and across the country, the IMDs are another resource we can use to better serve our Medicaid clients in need of treatment for substance use disorder.”

DHSS’ Division of Medicaid and Medical Assistance (DMMA) also received approval from CMS for an extension of its Medicaid demonstration project, Diamond State Health Plan, along with its SUD waiver amendment. Both approvals are effective from Aug. 1, 2019, through Dec. 31, 2023.

“We are very pleased to have approval of our demonstration waiver and the added SUD expenditure authority,” Delaware Medicaid Director Steve Groff said. “This will allow all Medicaid beneficiaries in Delaware to have access to high-quality SUD care.”

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The Department of Health and Social Services is committed to improving the quality of life of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.


DNREC Division of Fish & Wildlife begins treating downstate ponds for nuisance aquatic weeds

DOVER – With inland water temperatures rising and aquatic plants emerging, DNREC’s Division of Fish & Wildlife has begun annual treatment of select downstate public ponds for nuisance aquatic weeds. These nuisance weeds can overtake ponds and crowd out beneficial plant species and prevent fishing and boating access. Blairs Pond and Tub Mill Pond near Milford are being treated this year. Signs are posted at the boat ramp area of each pond on the day of treatment.

Hydrilla, a non-native, invasive plant that likely entered the state through the aquarium trade, is the primary target of the treatments through application of Sonar, an EPA-registered and approved aquatic herbicide containing fluridone. Sonar has been used in Delaware since the 1980s, and has proven environmentally-compatible and effective for controlling hydrilla. Sonar does not pose any threat to wildlife, including fish, nor are there any restrictions on fishing or fish consumption as a result of these treatments.

The only special precaution is a 30-day restriction on water use from the ponds from the date of treatment. Residents and farmers alongside the ponds and those directly downstream should not use pond water to irrigate their gardens, yards, or agricultural lands for 30 days following treatment to avoid possible damage to their plantings.

An annual permit from DNREC’s Division of Water is required to withdraw water from Delaware’s freshwater ponds, with holders of these permits receiving advanced notice of the upcoming pond treatments. To obtain an irrigation permit from the Division of Water, please call Bill Cocke, Water Allocation Section, at 302-739-9945. More information can be found on the DNREC website at Water Allocation.

Only state-managed ponds with public angler access are treated since the treatments are funded through the Federal Sport Fish Restoration Program and state fishing license funds. While the Division of Fish & Wildlife does not treat private ponds, it can provide a list of businesses licensed in Delaware to treat nuisance aquatic weeds.

To prevent the spread of invasive aquatic vegetation to other ponds and waterways, anglers and boaters are encouraged to remove all hydrilla and other aquatic plants from their boats, trailers, and gear before leaving the boat ramp area.

For more information on nuisance aquatic weed treatment of state-managed ponds, please call the DNREC Division of Fish & Wildlife Fisheries Section at 302-739-9914.

Follow the Division of Fish & Wildlife on Facebook, https://www.facebook.com/DelawareFishWildlife.

Contact: Joanna Wilson, DNREC Public Affairs, 302-739-9902

Vol. 49, No. 133


DHSS Launches START Initiative to Engage More Delawareans Suffering from Substance Use Disorder

WILMINGTON (Oct. 3, 2018) – As a way to engage more Delawareans suffering from substance use disorder in treatment, while also meeting their accompanying needs for housing, employment, education and other wraparound services, the Department of Health and Social Services (DHSS) today launched its START Initiative with a press conference and a daylong forum for stakeholders.

With the START Initiative, DHSS’ Division of Substance Use and Mental Health (DSAMH) will increase access to care and treatment for individuals living with substance use disorder by fostering system-wide improvement based on a framework that measures client outcomes. Last week, DSAMH launched a new online treatment referral system called Delaware Treatment and Referral Network (DTRN) that allows Delaware health care providers seeking substance use disorder treatment or mental health services for their patients to make an online referral with one of 24 organizations included in the first phase. Additional addiction and mental health treatment providers will be included in subsequent phases.

“These are important steps forward in meeting the immediate needs of people suffering from addiction in our state,” Governor John Carney said. “When I was running for Governor, I heard from many Delawareans about the problems their loved ones had in accessing treatment. With the new online treatment referral dashboard and peers in emergency rooms and at other contact points, we will engage people in getting the connection to treatment that they need and also be the support they can turn to in order to remain connected to treatment.”

In its first year, the Substance Use Treatment and Recovery Transformation (START) Initiative is expected to engage and treat more than 900 new clients using certified recovery peers connected to emergency departments, primary care, urgent care, EMS, police officers and families as the gateway. The peers will assist individuals suffering from substance use disorder as they navigate their way through both the treatment and social services systems, helping meet their needs for housing, transportation, employment, social services, legal or financial counseling, and other behavioral health or medical care. The START Initiative builds on the best evidence-based treatment and wraparound services needed for long-term recovery, but also offers technical supports to providers in the community to evaluate for quality and standards.

As part of the START Initiative, DSAMH awarded contracts to Brandywine Counseling & Community Services and Connections Community Support Programs as Level 4 providers, the highest level in Delaware for SUD treatment. That means the two organizations can provide clients with every level of treatments and services, including all three FDA-approved forms of medication-assisted treatment. Later this fall, DSAMH expects to add more treatment providers at each level of care. DSAMH also awarded a peer recovery specialist contract to Recovery Innovations International to help navigate individuals into treatment and to maintain their connection to that care.

“To reduce the toll that addiction is taking across our state, we must engage people suffering from substance use disorder in treatment available today. We know what works, now we need more patients with access to medication-assisted treatment combined with behavioral counseling and social supports,” said DHSS Secretary Dr. Kara Odom Walker, a board-certified family physician.

In April 2017, Secretary Walker asked a team of researchers and clinicians from the Johns Hopkins Bloomberg School of Public Health to conduct a review of Delaware’s treatment system. In July 2018, the Johns Hopkins team issued a 33-page report that proposed four main strategies:

  •  Increase the capacity of the treatment system.
  •  Engage high-risk populations in treatment.
  •  Create incentives for quality care.
  •  Use data to guide reform and monitor progress.

“The START Initiative is one of the first steps forward in embracing the recommendations of the Johns Hopkins report to strengthen the treatment system in our state,” Secretary Walker said. “Our goal is to offer care to individuals suffering from opioid addiction that is high-quality, comprehensive, coordinated, evidence-based and person-centered. The treatment hubs will care not only for the individual’s treatment needs, but also navigate the social determinants of health that often matter more in achieving overall health and positive treatment outcomes.”

In DHSS’ Fiscal Year 2019 budget, the General Assembly approved new addiction-related funding:

  • $990,000 for SUD assessment and referral to treatment of people who have overdosed or are suffering from addiction and have been brought to emergency rooms.
  •  $328,500 for 20 additional sober living beds.
  •  $100,000 for naloxone – the prescription medication that can reverse the effects of opioid overdoses – for first responders statewide.

Lt. Governor Bethany Hall-Long, who chairs the Behavioral Health Consortium, said the START Initiative dovetails with the action items in the consortium’s Three-Year Action Plan. “Better connecting people to care when they need it most was something we heard loud and clear from the community during the Behavioral Health Consortium’s statewide forums,” she said. “Peers who have been through the recovery process will play an important role in not only connecting individuals to those services, but also supporting individuals through treatment and involving family members as needed. The START Initiative is the next step to ensuring a more comprehensive and robust behavioral health treatment system for all Delawareans.”

In June, Governor Carney signed a budget passed by the General Assembly that included $3 million in funding for the Behavioral Health Consortium, more than half of which is allocated to increase treatment and recovery services, and $2 million for improvements to the Delaware Health Information Network (DHIN) that will include behavioral health claims.

The START Initiative received a boost of $2 million in federal funding through the State Targeted Response to the Opioid Crisis grant, made possible through the signing of the 21st Century Cures Act. Through the federal grant from the U.S. Substance Abuse and Mental Health Services Administration, Delaware received $2 million per year for two years. START also will receive funding from Medicaid reimbursements and state general funds.

“Opioid and heroin addiction is a disease that affects communities throughout Delaware and our nation. The devastating effects of addiction cut across geography and do not discriminate along racial, gender, socio-economic, or party lines,” said Congresswoman Lisa Blunt Rochester. “As a member of the Bipartisan Heroin Task Force, I was proud to support the 21st Century Cures Act, which provides funding for the START Initiative and works to expand treatment and recovery services. The human cost of addiction is too great, and we must continue to work toward collective solutions that make communities across the country healthier and safer for everyone. I look forward to seeing the positive impact the START Initiative will have on the lives of those in need.”

The new system of care ensures 24/7 support through certified peer recovery specialists who will meet with individuals suffering from addiction wherever they connect with the system – a hospital emergency department, a doctor’s office, EMS transport, a police encounter or through a family or self-referral. Once individuals are in treatment, peers will help clients to navigate and stay engaged in their own care. Peers also will engage family members as appropriate to discuss treatment questions, issues, needs, options and preferences. In addition, peers will connect pregnant women to existing programs that provide home visiting and prenatal care.

Help is Here LogoElizabeth Romero, director of the Division of Substance Abuse and Mental Health, said peers are critical to building trust in the treatment system among individuals suffering from addiction. “Relying on someone with a similar lived experience will help individuals suffering from substance use disorder to believe that treatment can work in their case and they can begin the road to recovery,” she said. “We know that addiction is a disease with a high rate of relapse, so peers can be the person that someone calls at 2 o’clock in the morning when they are afraid they might be tempted to use again.”

Under the START Initiative, providers will be required to track and report aggregate outcomes, including intake assessments, clinical progress and receipt of supplementary services. The first step in understanding that level of accountability came with today’s forum for treatment partners in which they learned about evidence-based practices and the need to improve the coordination of care.

That coordination will be enhanced by an Overdose System of Care, which will establish EMS and emergency department protocols to improve acute response, initiate medication-assisted treatment to manage withdrawal, and rapidly engage individuals with treatment. In September, Governor Carney signed legislation making Delaware the first state in the nation to have an Overdose System of Care.

“The Overdose System of Care will be an important complement to the START Initiative,” said Division of Public Health Director Dr. Karyl Rattay. “Once the protocols are established, we will have another way to engage high-risk populations into treatment through a statewide system that ensures consistent, humane, evidence-based treatment and care is available and provided to those requiring acute management for overdose or substance use disorder. The goal is simple: to save more lives and to engage more people into treatment.”

In 2017, emergency medical service responders administered 2,711 doses of naloxone – a prescription medication that can reverse the effects of an opioid overdose – to 1,905 patients in Delaware. Both totals were up more than 16 percent from the 2016 totals. Additionally, law enforcement officers administered naloxone to 149 people in 2017.

Deaths from overdoses also increased in 2017, with 345 people dying in Delaware, according to the Division of Forensic Science (DFS). That total was up about 12 percent from 2016. Through Oct. 1 of this year, 218 people have died from suspected overdoses in Delaware, including a record monthly total of 39 lives lost in August, according to DFS.

If you or a loved one is struggling with addiction in Delaware, call DHSS’ 24/7 Crisis Hotline to be connected to treatment and recovery options. In New Castle County, call 1-800-652-2929. Or in Kent and Sussex counties, call 1-800-345-6785. To search online for treatment and recovery services in Delaware or nearby states, visit www.HelpIsHereDE.com.


Division of Substance Abuse and Mental Health Launches Referral Network for Addiction, Mental Health Treatment Services

NEW CASTLE (Oct. 2, 2018) – The Department of Health and Social Services’ Division of Substance Abuse and Mental Health (DSAMH) last week launched its online referral network – Delaware Treatment and Referral Network (DTRN) – allowing Delaware health care providers seeking substance use disorder treatment or mental health services for their patients to make a digital referral with one of 24 organizations participating in the first phase.

DSAMH is partnering with OpenBeds, a leading provider of a health care technology solutions, whose platform identifies, unifies, and tracks behavioral health resources to create single, common networks; facilitates rapid digital referrals; and fosters collaboration among mental health, substance use and medical providers.

Within hours of last week’s launch of the Delaware Treatment and Referral Network, 13 behavioral health centers, hospitals, referral organizations, and other state agencies and support resources were using the online platform to connect patients to the appropriate and needed level of care. At launch, there were 24 treatment organizations statewide listing 66 mental health and substance use disorder (SUD) services. The collection of these network members represents the first phase of the project, which the Department of Health and Social Services (DHSS) intends to grow to include all mental health services statewide.

“Real-time online treatment referrals and acceptances are an important step forward in making our behavioral health system more responsive for the people we serve,” said DHSS Secretary Dr. Kara Odom Walker, a board-certified family physician. “Because of the Delaware Treatment and Referral Network, health care providers, in consultation with individuals and their families, won’t have to spend hours on the phone trying to find out if a treatment slot of bed is available. Faxed paperwork won’t get misplaced. And a bed won’t be given away to someone else while an individual seeking treatment tried to get to a treatment location.”

In 2017, 345 died in Delaware from overdoses, according to the Division of Forensic Science (DFS). Through Oct. 1 of this year, 218 people have died from suspected overdoses in the state, including a record monthly total of 39 lives lost in August, according to DFS.

DSAMH Director Elizabeth Romero said having real-time information about treatment availability is critical in helping health care providers make the best decisions about care for their patients. “The Delaware Treatment and Referral Network will expedite referrals for patients and ensure that treatment begins as quickly as possible,” Romero said. “Because treatment organizations will update their bed, slot or appointment capacity at least twice a day, referring health care providers will have a strong picture of what services are available for their patients.”

In its first week, Romero said the network facilitated 95 online patient referrals, with 72 requests accepted for treatment, six declined and 17 remaining open.

The Delaware Treatment and Referral Network also supports the identification of peer recovery support services and pre-authorizations by the Eligibility and Enrollment Unit at DSAMH for certain substance use disorder referrals. In the coming months, DSAMH will continue to add providers to the network and introduce additional functionality and support services. Ultimately, DHSS hopes to gain insights from the network that will help identify gaps in care, share best practices and better manage treatment resources.

“OpenBeds provides an amazing opportunity for providers across Delaware to remain informed throughout the referral process so that those we serve are able to be provided with care in a more transparent and efficient manner,” said Erin Booker, Corporate Director for Behavioral Health at Christiana Care Health System.

DTRN, in partnership with OpenBeds, coordinates multiple independent services and pool capacity, and captures real-time utilization data and referral patterns to:

  • Identify service gaps;
  • Effectively target funding;
  • Identify and scale successful services;
  • Produce program evaluations;
  • Cross-reference data with other databases.

“We are pleased to have the opportunity to make a positive impact on those in need of behavioral health treatment in Delaware,” said Nishi Rawat, M.D. and Founder of OpenBeds. As a critical care physician, Dr. Rawat experienced first-hand the frustrations of using inefficient manual processes to locate the proper care for her patients whose conditions she couldn’t treat in the facilities she was serving. “We thank the state of Delaware for this innovative and forward-thinking initiative to take immediate action in this increasingly challenging time of substance abuse and mental health crisis across the U.S. – one that is adversely affecting our communities, families, friends, and neighbors today.”

The OpenBeds platform already has been successfully deployed statewide in Indiana.

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The Department of Health and Social Services is committed to improving the quality of life of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.


DNREC Division of Fish & Wildlife begins treating downstate ponds for nuisance aquatic weeds

DOVER – With inland water temperatures rising and aquatic plants emerging, DNREC’s Division of Fish & Wildlife has begun annual treatment of downstate public-access ponds for nuisance aquatic weeds. These nuisance weeds, if left unchecked, can choke the water, crowding out beneficial plant species, and preventing fishing and boating access. Ponds being treated this year are Abbotts Pond near Milford, Concord Pond near Seaford, and Horsey Pond in Laurel.

Hydrilla, a non-native plant that likely entered the state through the aquarium trade, is the primary target of the treatments. The Division of Fish & Wildlife’s Fisheries Section is applying Sonar, an EPA-registered and approved aquatic herbicide containing fluridone, to the ponds where hydrilla is widespread. Sonar has been used in Delaware since the 1980s, and has proven environmentally-compatible and effective for controlling hydrilla. Sonar does not pose any threat to wildlife, including fish, nor are there any restrictions placed on fishing or consumption of fish as a result of these treatments.

Signs are posted in the boat ramp area of each pond on the day of treatment. The only special precaution is a 30-day restriction from the date of treatment on water use from the ponds. Residents and farmers alongside the ponds and those directly downstream should not use pond water to irrigate their gardens, yards, or agricultural lands for 30 days following treatment to avoid possible damage to their plantings.

To prevent the spread of invasive aquatic vegetation to other ponds and waterways, anglers and boaters are encouraged to remove all hydrilla and other aquatic plants from their boats, trailers, and gear before leaving the boat ramp area.

The Division of Fish & Wildlife treats only state-managed ponds with public angler access, since the treatment work is funded through the Federal Sport Fish Restoration Program and state fishing license funds. While the Division of Fish & Wildlife does not treat private ponds, it can provide a list of businesses licensed in Delaware to treat nuisance aquatic weeds. For more information on treatment of state-managed ponds, please call the Fisheries Section at 302-739-9914.

Residents also are reminded that in order to use water from Delaware’s freshwater ponds, an annual permit from DNREC’s Division of Water is required. Residents who have these permits receive individual advance notice of the upcoming pond treatments. For information on obtaining an irrigation permit from the Division of Water, please call Bill Cocke, Water Allocation Section, at 302-739-9945. More information can be found on the DNREC website at Water Supply. For the permit application, scroll down and click the link to “one-page short form application.”

Follow the Division of Fish & Wildlife on Facebook, https://www.facebook.com/DelawareFishWildlife.

Contact: Joanna Wilson, DNREC Public Affairs, 302-739-9902

Vol. 48, No. 140