1. National Council for Behavioral Health May 18, 2018
Federal Policy Update
National Council for Behavioral Health
May 18, 2018

2. Changing Policy & Practice Environment
Increased demand at same time as diminishing federal, state, and local resources
State and local systems undergoing accelerated change in organization and financing
Integrated care becoming expectation for payers, consumers, and families
Health IT linking behavioral health system to the rest of healthcare

3. News From Washington FY2018 omnibus funding bill passed in March.
Various executive and legislative actions repeal or undercut portions of the ACA.
CMS moves to permit work requirements, other restrictions on Medicaid benefits.

4. FY 2018 Appropriations Massive omnibus spending bill passed in March
+$10.1 billion for federal health spending
SAMHSA, NIH, CDC receive increases
$4 billion dedicated to addressing opioid crisis
Key programs:
CCBHCs (+$100 million)
PIPBHC (level funding)
Mental Health First Aid (+$5 million)
Opioid STR grants (doubled to $1 billion)
And more!

5. Trump’s Health Care Team
Alex Azar,
Secretary of HHS
Dr. Elinore McCance-Katz, Assistant Sec. for Mental Health
Seema Verma, Administrator of CMS

6. Likely Medicaid waiver proposals
Work requirements
Drug testing
Higher cost sharing
Use of HSAs
Special enrollment & lockout periods
Time limit on coverage
CMS rejected KS lifetime limit on coverage
“Disability” is often touted as a category of exemption from new waiver requirements.
“Disability” as a category for exemption
Does not include people with addiction
Does not include people with moderate-severity conditions accompanied by cognitive impairments
“Medically frail” may be a better exemption category
Education of policymakers is needed!

7. Medicaid Work Requirements
CMS released guidelines for states to create work requirements
At least 10 states have submitted waivers
Proposals approved in Kentucky, Indiana, Arkansas
Non-exempt individuals must complete 20+ hrs/week of work, job training, job search or “community engagement” activities
Lawsuit pending against HHS & CMS

8. Opioid deaths are still on the rise

9. House Response
Energy & Commerce is in the midst of hearings to consider dozens of bills with various solutions:
Telehealth
Alternatives for pain management
IMD exclusion
Recovery housing best practices
Research
Grant-funded services
SUD Workforce
Incentivize EHR use

10. Other Recent Legislation
Excellence in Mental Health and Addiction Treatment Expansion Act: More states allowed to implement CCBHCs
Mental Health Access Improvement Act: Medicaid billing for MFTs/MHCs
Multiple loan forgiveness bills for professionals in addiction settings
Behavioral Health IT Act: Demonstration to help BH providers adopt electronic health records
NOTE: CAVEAT…
Investment via grants, not coverage
Need for health-related “moving vehicles” to pass any of these bills
Other bills introduced: CARA 2.0, CHRONIC Care Act, Medicaid CARE Act, Telehealth proposals

12. Shifting Focus from Volume to Value
Volume (FFS)
Value
Capitation
Shared Savings
Pay for Performance
Episodic Bundles
Incentives for health system investment in behavioral health care
In most of these payment models, there is very little downside risk
Understandable for the early years of an experiment, need to get lots of people to participate
This is slowly changing
Reduce ED overcrowding
Improve bed availability
Reduce inpatient length of stay
Prevent unnecessary readmissions
Improve clinical outcomes & reduce cost of care for complex, chronically ill populations

14. 1. Be Accessible
Can schools, child welfare, ACOs and healthcare homes get their clients/patients into specialty MH/SU care with same day/next day access, especially for high risk, high need patients?
Superb Access to Care

15. 2. Be Efficient
Do you have the ability to identify patients with MH/SUD who represent the top 5% to 10% of high cost consumers of health care and provide effective care management services to help them manage their MH/SU disorders AND their chronic health conditions?
Care Coor-dination
Team Care

16. 3. Connect with Other Providers
Do you use a collaborative care approach to clinical services?
Are you actively pursuing bi-directional involvement in your community as a person-centered healthcare home?
Can you electronically collect and share both demographic and clinical-level data with your partners in the healthcare community?
Clinical Information Systems

17. 4. Focus on Episodic Care Needs
Do you have well defined assessment processes and defined levels of care based on clinical pathways, functionality in daily living activities, symptom severity indicators, service volumes, etc. to match client need with the type, location, and duration of evidence-based care that increases the likelihood that consumers will get their needs met in a timely and effective manner?

18. 5. Produce Outcomes
Do you use standardized tools to measure improvement (or not) in symptomology, level of functioning, resilience and recovery?

19. Things to Consider for Your Future
How do you collect and report quality measures?
Do your staff (and state leaders) have a population-health perspective?
How will you systematically implement self-management training and support?
How will you support clinical information system adoption and implementation?

20. Questions?