WHAT IS AHEAD?The Changing Environment for Substance Use Disorder Services
Policy Impacts• Affordable Care Act (healthcare
reform)• Wellstone/Domenici Parity Act• SAMHSA/ONDCP Leadership
Direction• Public Funding Environments (Fed &
TX)
Affordable Care Act (healthcare reform)
• Passed in March 2010- fully in effect 2014
• Includes substance use disorder & mental health (SUD/MH) services as part of essential benefit package in exchange plan
• Requires that all plans comply with the Wellstone/Domenici Parity Act in providing SUD/MH benefits in the same way as all other covered medical and surgical benefits.
•Expands Medicaid eligibility for all Americans up to 133% of federal poverty level; both male & female custodial & non-custodial eligible
•Includes SUD and MH prevention strategies and efforts in the bill’s chronic disease initiatives.
•Four strategic directions of the National Prevention Strategy includes Preventing Drug Abuse and excessive Alcohol Use as a priority
Affordable Care Act (healthcare reform)
Wellstone/Domenici Parity Act
The law requires that any group health plan that covers
more than 50 employees and offers mental health
and/or substance use disorders coverage must provide
that coverage with no greater financial requirements
(i.e., co-pays, deductibles, annual or life-time dollar
limits) or treatment limitations (i.e., number of visits)
than the predominant requirements the plan applies to
substantially all medical / surgical benefits. Note,
however, that the law does not require employers to
cover mental health or substance use treatments if they
are not already offered.
SAMHSA LEADERSHIP DIRECTION
More collaboration between SA and MH (Behavioral Health)---Also, among federal agencies◦ Combined Block Grant Application: Braided Funding◦ Co-occuring Disorders
Integration of BH and primary care◦ FQHC’s/medical homes
Recovery Focus/Recovery Support Services Trauma Informed screening and treatment Military Families & Unique Cultures: Ethnic minorities;
LGBTQ populations; Tribes; Women and girls Outcome Measures and Data Collection- standardization Prevention (Suicide, Tobacco, Underage drinking,
prescription drugs) ◦ Focus on Communities--Prevention Prepared
Communities / Strategic Prevention Framework
ONDCP National Drug Control StrategyDevelop Prevention-Prepared CommunitiesSpread Prevention to the Workplace Enable Law Enforcement Officers To Participate in
Community Prevention Programs in Schools, Community Coalitions, Civic Organizations, and Faith-Based Organizations
Preventing Drugged DrivingExpand and Evaluate Screening for Substance
Use in All Health Care Settings Identify & Make Available Additional Training in
Evidence-based Practices for Substance Use Disorder Assessment and Care to Healthcare Professionals Providing Care to Military Health System Beneficiaries
ONDCP National Drug Control Strategy
Expand Addiction Specialty Services in Community Health Centers
Increase Addiction Treatment Services Within the Indian Health Service
Foster the Expansion of Community-Based Recovery Support Programs, Including Recovery Schools, Peer-Led Programs, Mutual Help Groups, and Recovery Support Centers
Tackle Co-Occurring Disorders Using a Community-Based Response
Public Funding Environments
Budget constraintsUnprecedented economic
challenges
Of the first trillion dollars of budget cuts, a third will come out of defense spending. The other two-thirds will come out of education, job training, infrastructure, low-income housing, energy assistance, research and development of alternative energy sources and other "discretionary" programs.The remainder of the budget cuts will be decided by the end of the year. A congressional commission will present Congress with recommendations for $1.5 trillion more in cuts
DEFICIT REDUCTION:
TEXAS
Public Funding Environments
•$3.8M Biennial SUD budget reduction
•$3.8M block grant reduction for not meeting MOE
•5% Medicaid Rate Reduction (Avoided)
•Criminal Justice Initiative Funding stayed fairly in-tact.
•SUD Medicaid Benefit under legislative Review for Cost Effectiveness
PHYSICAL MEDICINE
Creation of American Board of Addiction Medicine: ABAM is the nation’s first medical specialty board
Medicare codes for SBIRT Reimbursement for screening and brief intervention is available through commercial insurance CPT codes, Medicare G codes, and Medicaid HCPCS codes.
The American Society of Addiction Medicine (ASAM) has released a new definition of addiction highlighting that addiction is a chronic brain disorder and not simply a behavioral problem involving too much alcohol, drugs, gambling or sex. This the first time ASAM has taken an official position that addiction is not solely related to problematic substance use.
MOVING FORWARD:What to Expect: Behavioral Health- less separation
between MH & Substance Abuse Integration with Primary Care- ACOs and Patient-Centered Medical
Home(health home) models/FQHC’s Coding and electronic billing (EDI) Managed care and utilization review Private Insurance, Medicaid as primary
payers Competition Marketing
MOVING FORWARD:
What to ExpectJoint-venture /partnerships /Mergers &
AcquisitionsEmphasis on mission-critical IT (infrastructure,
certified systems, Meaningful Use)Shared services (technology networks)Quality management and reportingMedication assisted treatment (MAT)Care/Case MgmtStandardizationMore Outpatient--Room & Board separate from
“residential”
MOVING FORWARD:
What to Expect
Population Health Mgmt (Wellness)- “lifestyle” disease prevention
Coalitions /Community “grants”Veterans and Military/Special Populations
focusRecovery Support ServicesPublic/state funding for criminal justiceHigher credentials / peer specialistsWorkforce Shortages
MOVING FORWARD What Does it Look like for……
Quick Scan
Focused on a Public funding. Predominately (DSHS).
Attention to DSHS Mental Health and Substance Abuse Division policies & contracts
Little attention to Private sector funding
Limited Alliances- mostly sharing information / legislative issue support
Solely SUD
Attention to TDCJ, TDI, HHSC (Medicaid) and TEA or DFPS. Varied contract stipulations & Varied Regulation
More interaction with Insurance (private & Medicaid), Corporate, Foundations, Private Pay, other state funding
Stronger partnerships with Texas Council, TAAP, ASAM, others
Behavioral health w/ SUD expertise
FUTURENOW
Quick Scan
Solely ATOD prevention
CHMBS
Discharge Planning/Aftercare
Provider waiting lists Competing for Grants Awareness of
Services/Outreach
Experienced Leadership
“Wellness”, Mental health promotion & Lifestyle illness prevention with ATOD specialty. Family Services.
Integrated technology/software systems
Recovery Support Services
Client Choice Competing for Patients Marketing Services
CEO retirements/Succession planning/Leadership Development
NOW FUTURE
Quick Scan
Education focus- Clinical, Programming, Contract Management, Leadership
Meetings & conferences
Little Primary Care interface
Licensure Little Quality Management Assist
Primary group representing Substance Use Disorders along with TAAP
Business Education & Leadership
Webinars, E-learning & conferences
Arrangements as specialty care providers in FQHC’s, ACA’s, Hospital Emergency Rooms
Accreditation & ASAM standards, Quality Management Assistance
Mental Health American& Texas Council including substance abuse in their Behavioral Health missions, Emergence of Grassroots Recovery Organizzation “Texas Recovers”
NOW FUTURE
Quick Scan
Now
Communication: Email, Ezine, as needed teleconference briefings, limited website
Predominately Publicly funded members
Member focused advocacy
State-level advocacy Dues funded Independent organization
Future
Websites- Social Media—library- podcast reports
For-Profit organizations, criminal justice providers, recovery support
Grassroots Involvement Build Federal Lobby
capacity Diversification: Revenue
Sharing, Product Sales, Private Grants
Merger
Strategic Directions
•Re-phrase language and message to indicate we are a specialty of Physical Health, Behavioral Health, and Wellness
•Develop active stakeholder relationships (like DSHS) with other state agencies: HHSC (Medicaid), TDI, Criminal Justice .
•Develop functional Partnerships with Allied Organizations
•Update Communication Strategies
•Strengthen Federal Advocacy
The Language of Transformation
Traditional Transformational Drug and Alcohol Abuse Mental Health & Mental
Retardation
Substance Abuse Chemical Dependency
Counselor
Client Outlyer
Mental Health & Substance Abuse Behavioral Health
Addictive Disorders Substance Use Disorders Substance related
conditions Clinician
Patient Medical Specialty
The Language of Transformation
Traditional Transformational
DetoxificationResidential /
OutpatientDay TreatmentRehab”TreatmentPrevention
Inpatient Acute Medically managed care Inpatient nonhospital
rehabilitation facility Sub-Acute rehabilitation Partial Hospitalization Medically monitored care Self Maintenance Health Promotion Prevention in terms of
Wellness Prevention in terms of
Lifestyle Diseases
A Behavioral Health Leadership Organization