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Mental Health and SUD: Opportunities in Health Reform

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Mental Health and SUD: Opportunities in Health Reform Barbara Edwards, Director Disabled and Elderly Health Programs Group Center for Medicaid, CHIP, and Survey ... – PowerPoint PPT presentation

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Title: Mental Health and SUD: Opportunities in Health Reform


1
Mental Health and SUD Opportunities in Health
Reform
  • Barbara Edwards, Director
  • Disabled and Elderly Health Programs Group
  • Center for Medicaid, CHIP, and Survey
    Certification
  • Centers for Medicare Medicaid Services
  • October 14, 2010

2
CMCS and Behavioral Health
  • Medicaid is the largest payer for mental health
    services in the United States
  • In 2007, Medicaid funding comprised 58 of State
    Mental Health Agency revenues for community
    mental health services
  • Comprehensive services available through
    Medicaid many are optional under Medicaid so
    states have considerable flexibility in benefit
    design

3
Medicaid MH/SA Service Users
Source SAMHSA
4
Medicaid Expenditures for MH/SA Service Users
Source SAMHSA
5
MH/SUD DEHPG Goals
  • Federal policy supports the offer of effective
    services and supports
  • Improved integration of physical and behavioral
    health care
  • Person-centered, consumer-directed care that
    supports successful community integration
  • Improved accountability and program integrity to
    assure Medicaid is a reliable funding option

6
A System of Coverage
Medicaid/ CHIP
Exchange
Employer Coverage
7
Affordable Care Act Sources of Coverage Under
Age 65 (2019)
24m
51m
22m
25m
159m
Source Congressional Budget Office, March 2010
8
New Paradigm
  • Not a safety net but a full partner in assuring
    coverage for all
  • Eligible enrolled
  • Essential to make a system out of different
    components to achieve coverage, quality and cost
    containment objectives

9
Newly Eligible Individuals
  • An estimated 5.4 million people that are
    currently uninsured with a MH/SUD problem would
    gain coverage under the ACA
  • 50 of those individuals likely to be served
    Medicaid.
  •  

Donohue J, R Garfield, and J Lave, The Impact
of Expanded Health Insurance Coverage on
Individuals with Mental Illnesses and Substance
Abuse Disorders ASPE Report April 2010.
10
Benefit Design Issues
  • The new Medicaid expansion population must
    receive benchmark or benchmark-equivalent
    coverage
  • Benchmark plans comparable to Federal Employee
    Blue Cross/Blue Shield Health Benefits, States
    employee health insurance plan, or States
    largest commercial HMO plan
  • Benchmark equivalent Actuarially equivalent to
    above plans

11
ACA and Benchmark Plans
  • In 2014, benchmark and benchmark equivalent
    plans must begin providing at least essential
    health benefits (section 1302 (b))
  • Mental health and substance use disorder
    services, including behavioral health treatment
    are included as a category within essential
    health benefits
  • MHPAEA/MH Parity applies
  • Secretary will issue guidance

12
Medicaid for ABD
  • New eligibility option not available to those
    eligible for SSI or those 65 years of age and
    older
  • New benchmark plan does not change state options
    regarding traditional Medicaid, including ABD

13
ACA Medicaid Behavioral Health
  • Provides new state plan and grant opportunities
    that include opportunities to address mental
    health and/or substance use disorder
  • Implementation teams within CMCS seek to engage
    stakeholders
  • Engagement strategies vary, based on topic,
    timetable

14
ACA Medicaid Behavioral Health
  • 1915 (i) waiver-like services offered under
    State Plan Option (10-1-2010)
  • Can target populations
  • Adds additional service, income options
  • Extends and expands Money Follow the Person
  • Enhanced FMAP available through 2016
  • Enables a new solicitation

15
ACA Medicaid Behavioral Health
  • Health home, chronic conditions (1-1-2011)
  • MH, SUD are conditions that are eligible
  • Enhanced FMAP for 8 quarters
  • State/SAMHSA collaboration
  • Community First Choice (10-1-2011)
  • Enhanced FMAP for Community attendant services
  • Balancing Incentives Program (10-1-2011)
  • Enhanced FMAP for HCBS for 5 years

16
Non-ACA Priority Provisions
  • MHPAEA/Mental Health Parity - applies to Medicaid
    managed care plans (MCOs), CHIP State Plans, and
    benchmark plans
  • Targeted Case Management option final
    regulations
  • Rehabilitation option

17
Opportunity for System Transformation
  • This is a time of unprecedented opportunity to
    transform the system of care for individuals with
    disabilities
  • CMS new Administrator, Dr. Donald Berwick, M.D.,
    has articulated how this transformation can be
    achieved

18
The Triple Aim
Population Health
Per Capita Cost
Experience Of Care
19
The Foundation for a Redesigned Service System
for Individuals with Chronic Conditions
20
Person Centered
  • Person centered plans of care
  • Individuals and people important to them
  • Functional assessments
  • Individuals experience of care

21
Individual Control
  • Choice
  • Self-direction through both waivers and state
    plan options
  • EHR
  • Education, Information

22
Quality
  • CHIPRA and Adult Quality Measures
  • Quality Improvement Program development
  • Quality reporting imbedded in new HCBS services

23
Integration
  • Single entry point/no wrong door (ADRC funding)
  • Models of integration
  • primary, acute, LTC
  • behavioral health and physical health
  • Medicare and Medicaid

24
Good and Modern
  • CMCS is very interested in SAMHSAs initiative
  • Looking for new opportunities to collaborate to
    encourage effective Medicaid coverage and services
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