Healthcare Reform and Beyond Advancing the Conversation The Impact of National Trends on NC May 27, 2010

2 Reform Preview Overview of what the new healthcare system will look like Review of key addiction related-provisions Timeline for implementation Next steps

3 National Healthcare Reform After more than a year of work, missed deadlines, and compromises, the healthcare reform bill was passed and signed into law on March 23, 2010 Some provisions take effect immediately but most will take effect in 2014, with full implementation by 2019 Once fully implemented, CBO estimates that 95 percent of the legal population will have health insurance

4 Key Things to Keep in Mind Preliminary discussion Statute provides framework, lots of remaining questions/ambiguity Scope of services/continuum of care not defined Years of regulations expected Enormous need for education and outreach

5 What does it do? Creates health exchanges for individuals and small employers to pool risk and purchase insurance Requires transparency, mandated benefits and other consumer protections Provides sliding scale subsidies for individuals and families up to 400% FPL to purchase or take up offers of health coverage Prohibits insurers from denying coverage to people with pre-existing conditions, charging higher premiums based on gender or health status, and placing annual or lifetime caps on insurance coverage Requires individuals to carry health insurance or pay a financial penalty

6 What else? Expands Medicaid eligibility to all Americans below 133% FPL Mandates newly-eligible childless adults be enrolled in generally less-comprehensive “benchmark” plan To finance the expansion, states will receive 100% FFP for , 95% FFP for , and 90% FFP after 2019 for expansion population Allows adult children to remain on their parent’s insurance until their 27 th birthday Creates a national high-risk pool for adults with preexisting conditions to buy into until implementation

7 Key SUD/MH provisions SUD/MH services included in the basic benefits package required in the exchange All plans in the exchange must adhere to the provisions of the Wellstone/Domenici parity act The parity act already applies to large group plans that would exist outside the exchange Requires that newly-eligible Medicaid enrollees, including childless adults, receive adequate health coverage that includes SUD/MH coverage

8 And…. Includes SUD/MH in chronic disease prevention initiatives Includes SUD/MH workforce in health workforce development initiatives Makes SUD prevention, treatment, and MH service providers eligible for community health team grants aimed at supporting medical homes

9 Implementation Timeline Some provisions take effect immediately or in the next several months. Biggest changes take effect on January 1, 2014, with full implementation by 2019.

10 Key provisions for 2010 Young adults can remain on their parent’s health plan until they turn 27 Preexisting condition exclusions prohibited for children Group or individual market plans are prohibited from rescinding coverage once an enrollee is covered under a plan, except for cases of fraud Prohibition against lifetime benefit caps and “unreasonable” annual limits National high-risk pool for people with preexisting conditions created; includes federal subsidies States have option to extend Medicaid coverage to childless adults up to 133% FPL under current FFP Eliminates cost-sharing for preventive care in Medicare and private plans

11 Key provisions coming in 2014 All other insurance market reforms, including: Guaranteed issue and renewability, prohibition of rating based on health status Elimination of all annual and lifetime limits State insurance exchanges for individuals and small employers with. After 2017 states can open exchange to large employers. Exchange subsidies for those up to 400% FPL become available Essential benefit requirements become effective

12 And… States are required to extend Medicaid coverage to all up to 133% FPL Individual mandate becomes effective Individuals that cannot demonstrate that they have qualifying coverage or are exempt will have to pay $95 or 1% of taxable income in 2014, increasing to $695 or 2.5% of taxable income in 2016 Limited employer responsibility requirement Quality improvement provisions take effect

13 Next steps 2014 will be here before we know it. Implementation will be fast and furious. Federal agencies are already beginning to draft regulations Most important regulations related to SUD/MH include: Benefit design Continued guidance on parity Changes within Medicaid Healthcare delivery system—medical home and other models of care Workforce Chronic disease prevention

14 Questions? Gabrielle de la Gueronniere and Dan Belnap Legal Action Center

Beyond Healthcare Reform Moving the Addiction Field Forward

All of this impacts how we: Reach patients (yes, patients) Organize care Deliver services Finance what we do for the 23 MILLION people with this condition

SO WHAT’S THE PROBLEM? Surprise! Change of any kind is difficult. Simplistically, our providers fall into three categories.

Early Adopters

Enough said

And… the Deer in the Headlights

So, what can we do? Encourage EEEE them and use them as ‘missionaries ’ Provide the information and do the best we can Intervene before they get run over

Strategy for Transformation The intervention should include: Where we are headed Why it’s a good thing How the change will happen Opportunities and Threats Strategies for surviving and thriving Business Tools Advocacy, Advocacy, Advocacy

Strategy for Transformation Moving the message Provider trainings by state or region E-strategies NIATx tools and ACTION Campaign SAAS dissemination with associations Addiction field media SAMHSA and other government agencies

Where change will come from: Federal policies, regs, contracts State policies, regs, contracts Provider initiatives Patients and their families Payers: private and public Strategy for Transformation

Targets of advocacy SAMHSA ONDCP FQHC Primary Care Insurance industry MCOs States Insurance Commissioners … to name a few Strategy for Transformation

Role of the Block Grant Transition funding Cover the uninsured Services for “habilitation” Wrap-around services Recovery support services

The Key : Provider Associations Service providers cannot, nor should they, drive this road alone. They have information and experiences that often go untapped.

The Key : Provider Associations Associations play a crucial role in providing avenues for exchange sharing the challenges, successes and opportunities.

The Key : Provider Associations True transformation will not happen without it.

There is an undeniable need… But if the demand creates a void, someone else will step in and fill it.

There has never been a more urgent and necessary call for intervention.

Take a step as an agency… Decide if your business is worth investing in, if so: 1. Join and participate in your association 2. Join the Niatx ACTION Campaign 3. Attend the SAAS/NIATx conference 4. Budget for Planning 5. Budget for Training 6. Budget for Assistance

Take a step as an association… Decide if the NC system is worth investing in, If so: 1.Develop a plan of action 2. Plan a 1-2 day(s) provider training 3. Reach out to other “non traditional” advocacy groups 4. Actively participate at the Nat’l level 5. Network and learn from other associations

There’s work to be done… Becky Vaughn State Associations of Addiction Services 236 Massachusetts Ave. Ste 505 Washington, DC