Healthcare Financing and Services FPMU120: HEALTH POLICY FOR HEALTHY LIFESTYLES YUYAN SHI, PHD DEPARTMENT OF FAMILY MEDICINE AND PUBLIC HEALTH UNIVERSITY OF CALIFORNIA, SAN DIEGO SPRING 2016

Lecture Outline  Announcements Homework assignment #2 due 4/28/ :00pm Group presentation  Individual presentation on health policy topics  This lecture: Learning objectives Behavioral services provided by Medicare, Medicaid and required by federal laws Federal and state funded programs to improve healthy lifestyle Acknowledgement: part of this presentation is derived from health-and-addiction-coverage

Group Presentation  Please sign up!!!  Send presentation materials to TA 24 hours before the designated dates.  Send presentation topic to TA 48 hours before the designated dates. Who are you representing? Who is your audience? What is your policy?

Previously in FPMU 120…  Described the age restrictions for tobacco, alcohol, and marijuana Minimum legal sale age Minimum legal consumption age  Discussed the public health implications of minimum legal sale age Delay initiation Reduce prevalence Save costs Improve length and quality of life

Previously in FPMU 120…  Defined key elements and described rationale of location restrictions Zoning policy: access, marketing and promotion, social norms, health disparity Consumption in public: secondhand exposure, drugged driving, social norm  Defined key elements and described rationale of licensing policies

A Few Clarifications  Legal consumption age of alcohol in California: 21 state=CA state=CA D= D=  Smoke-free vehicle laws Applied when underage persons are present (under age 6- 18)

Learning Objectives  Identify key provisions related to healthy lifestyles in: Medicaid Medicare  Identify key provisions related to healthy lifestyles in: 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) 2010 Patient Protection and Affordable Care Act (ACA)  Describe federal and state funded programs for healthy lifestyles

Insurance Coverage  Prevention Preventive care Wellness program  Treatment Behavioral health services

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*Medicaid  Prevention Obesity screening and treatment Tobacco use screening and treatment Programs vary by state  Treatment: the single largest payer for mental health services and increasingly playing a larger role in the reimbursement of substance use disorder services

*Medicare: Prevention  Screening and counseling Alcohol misuse, HIV, nutrition therapy, obesity, sexually transmitted infections, tobacco use  Silver Sneakers A comprehensive program that improves overall well- being Medicare Part C (Medicare Advantage Plans) may provide this program Provides access to fitness equipment, group exercise classes, social networking, online education and a sense of community

Medicare: Treatment  Covers a wide range of mental health services Part A (hospital insurance) Part B (medical insurance) Part D (prescription drug)

*2008 Mental Health Parity and Addiction Equity Act (MHPAEA)  Requires group health plans and health insurance insurers to ensure financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder benefits are not more restrictive than those applied to all benefits  MHPAEA applied to both private and public sector employers with more than 50 employees

 MHPAEA does not mandate a plan to provide mental health or substance use disorder benefits  MHPAEA does not apply to issuers who sell health insurance policies employers with 50 or fewer employees or who sell health insurance policies to individuals *2008 Mental Health Parity and Addiction Equity Act (MHPAEA)

*2010 Patient Protection and Affordable Care Act (ACA)  Intended to provide affordable coverage options for behavioral health through Medicaid and Health Insurance Marketplace Expanding coverage Providing mental health and substance use treatment Medicaid expansion State Exchanges Prevention and public health fund Integrated care models

*ACA: Expanding Coverage  New law expands access to health care coverage including mental health care and substance use treatment An individual mandate will require most individuals to obtain insurance Guaranteed issue- no one can be denied insurance coverage based on preexisting conditions Medicaid will expand to 133% of the federal poverty level in 2014, for those states that choose to opt in to Medicaid Expansion For states that opt out of expansion, there will be a gap in mental health and addiction coverage

*ACA: Mental Health and Substance Use Preventive Care  A list of essential benefits (EHB) must be covered in new plans offered to the uninsured  Essential benefits must include 10 required categories of essential health benefits  The state can decide to enhance the benefit package  Included in the EHB are preventive services: For adults: alcohol misuse screening and counseling, depression screening and tobacco use screening and cessation interventions For women: domestic and interpersonal violence screening and counseling, expanded tobacco use counseling for pregnant women For children: behavioral assessments, depression screening for adolescents and alcohol and drug use assessments

*ACA: Medicaid Expansion  New eligible: 133% of the federal poverty level equals $14,404 for individuals and $29,327 for families of 4 Mental health and substance use benefits that are required of plans offered through the Exchanges will apply to those newly eligible for Medicaid through the expansion Federal parity requirements (MHPAEA) will also apply to those newly eligible for Medicaid

ACA: State Exchanges  ACA requires establishment of state-based health plan ‘Exchanges' or ‘Marketplaces' through which individuals and small businesses can purchase coverage with pooled risk and lower premiums  Behavioral health services are required as essential benefits in the state exchanges

ACA: Prevention and Public Health Fund  $2 billion will be put towards prevention and public health programs each year: Community Transformation Grant Program (CDC) National Prevention Strategy (CDC) Public Health Workforce Development (HRSA) Mental Health Training (HRSA) Primary and Behavioral Health Integration (SAMHSA) Suicide Prevention (SAMHSA)

*ACA: Integrated Care Models  Before ACA, lack of integration between primary care and specialty behavioral health care and poor coordination for patients with coexisting mental health and addiction disorders  ACA integrated care models create additional incentives to coordinate primary care, mental health, and addiction services. Grants and Medicaid reimbursement are available for the creation of health homes for individuals with chronic health conditions, including mental illness and substance use disorders

State Funded Programs on Prevention and Treatment

*State Tobacco Control Programs  States that made larger investments in tobacco prevention and control have seen larger declines in cigarettes sale  Essential components: State and Community Interventions Mass-Reach Health Communication Interventions Cessation Interventions Surveillance and Evaluation Infrastructure, Administration and Management

State Alcohol and Drug Rehab  Target patients who are low income, without a quality health insurance plan  Advantages Price Professionals Accountability  Challenges Quality Uninterested patients Wait times Lack of long-term treatment options

Federal Food Programs  Federal assistance: Child and Adult Care Food Programs Provide a daily subsidized food service 3.3 million children and 120,000 adults participated Target children and older adults, chronically impaired disabled persons  National School Lunch Program Schools get cash reimbursement for the meals 32 million children participated  National School Breakfast Program 12 million children participated

This Lecture  Identified key provisions related to healthy lifestyles in: Medicaid Medicare  Identified key provisions related to healthy lifestyles in: 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) 2010 Patient Protection and Affordable Care Act (ACA)  Described federal and state funded programs for healthy lifestyles

Next lecture Policy Making Policy making and content analysis Problem definition and agenda setting Interest group Policy Strategies Mass media tools Economic tools Legal tools Regulatory tools Healthcare financing Policy Evaluation Quasi-experimental design Cost-effectiveness Cost-benefit Non-experimental and RCT Criteria selection