Health Care Reform, Part 1 Presentation to NAMI John O’Brien Senior Advisor on Health Financing SAMHSA

3 Changing Environment Major Drivers – More people will have insurance coverage – Medicaid will play a bigger role in MH/SUD than ever before – Focus on primary care and coordination with specialty care – Major emphasis on home and community based services and less reliance on institutional care – Rethink what is offered as a benefit – Outcomes: improving the experience of care, improving the health of the population and reducing costs

4 Changing Environment 61% of individuals served by State Substance Abuse Authorities are uninsured at any given point 39% of individuals serves by SMHAs are uninsured at any given point States that have expanded eligibility still have individuals with MH/SUD have a disproportionally higher of being uninsured (MA experience)

Major Drivers Medicaid Will Play A Bigger Role – Almost 1/3 of the SA providers and 20% of MH providers do not have experience with 3 rd party billing—including Medicaid. – Less than 10% of all BH providers have a EHR that is nationally certified. – Many staff don’t have credentials required through practice acts MCOs

Major Drivers Primary Care and Specialty Coordination— Why All the Fuss? – 20% of Medicare and Medicaid patients are readmitted within 30 days after a hospital discharge – Lack of coordination in “handoffs” from hospital is a particular problem – More than half of these readmitted patients have not seen their physician between discharge and readmission – Most FQHCs and BH Providers don’t have a relationship

7 Other Major Drivers State long term care systems still unbalanced – Some states still have more than 75% of LTC spending in “institutions” – Access to HCB services is limited—historical issues (limited Waiver slots) – Continued concerns about the quality of these services

8 Strategies Outreach and enrollment strategies that can be tailored for the populations with MH/SUD Younger with some income—how can we use ICTs Homeless—little documentation for applications Youth and families—who may have coverage options now but haven’t applied and enrolled SAMHSA Summer work—looking at strategies that can help people get enrolled Work in FY 2012 with consumer and provider organizations

Strategies Primary Care Opportunities—Help folks get to: – Community health centers—more focus on identifying and treating BH conditions – Health homes—SMI and SUD a critical focus for individuals with chronic conditions – Information to describe what is a Primary Care Physician, how do I get an appointment etc.

10 Strategies SAMHSA/CMS Work: – State by State Consultation on Primary Care and BH Integration – Regional Meetings to plan for implementation of 2703 – HRSA/SAMHSA funded Center for Integrated Health Solutions work with providers and States – Requesting that State’s provide SAMSHA a description of their approach in the FY 2012 Block grant Application

Strategies Home and Community Based Services: – Don’t lose sight of alternatives to long term residential—especially for children – Self direction and participant directed care – Taking advantages of programs that can rebalance systems (MFP, 1915i)

12 Strategies SAMHSA work involves: – Working with a cross agency group on 2402(a)— standards for home and community based services – Asking States in their BG application to provide strategies regarding self-direction – Community Integration project – Continued work with CMS and DOJ regarding Olmstead

Strategies Rethinking What SAMHSA buys: – Good and modern services – Additional areas of focus Prevention Recovery Children and Youth Services – Common service definitions for BG dollars – Looking at the evidence

14 Strategies SAMHSA efforts include: – Technical Panels to provide recommendation to federal partners, States and stakeholders regarding services – Working on cross agency team regarding essential health benefits

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