WHAT IS AHEAD? The Changing Environment for Substance Use Disorder Services

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