The Affordable Care Act, Integration, and the Addiction Workforce:Challenges and Opportunities

David DickinsonSAMHSA Regional Administrator

DHHS Region X

NAADAC 2014 Annual ConferenceSeattle, WA September 29, 2014

3

ACA and Washington State(as of April 2014)

• 163,207 individuals selected a Marketplace plan between October 1, 2013 and March 31, 2014

• 420,188 Washington residents have gained Medicaid or Children’s Health Insurance Program (CHIP) coverage through the end of March 2014

• 583,395 Total new beneficiaries

• expands mental health and substance use disorder benefits and federal parity protections for:

• 1,356,515 Washington residents.

http://www.hhs.gov/healthcare/facts/bystate/ca.html

4

STATE PREVALENCE OF SUD AMONG MEDICAID EXPANSION POPULATION

l Line indicates 95% confidence interval

Alabama

Arizona

California

Connecticu

t

Distric

t of C

olumbia

GeorgiaIdaho

Indiana

Kansas

Louisi

ana

Maryland

Michigan

Mississ

ippi

Montana

Nevada

New Jerse

y

New York

North Dako

ta

Oklahoma

Pennsylva

nia

South Carolina

Tennessee

Utah

Virginia

West

Virginia

Wyo

ming0%

10%

20%

30%

40%

50%

60%

5

STATE PREVALENCE OF SUD AMONG EXCHANGE POPULATION

Alaba

ma

Alask

a

Arizon

a

Arkan

sas

Califo

rnia

Conne

cticu

t

Delaw

are

Flor

ida

Georg

ia

Idah

o

Illino

is

Indi

ana

Iowa

Kansa

s

Kentu

cky

Loui

siana

Mai

ne

Mar

yland

Mich

igan

Miss

issip

pi

Miss

ouri

Mon

tana

Nevad

a

New H

amps

hire

New Je

rsey

New M

exico

New Y

ork

North

Car

olin

aOhi

o

Oklaho

ma

Orego

n

Penns

ylvan

ia

South

Car

olin

a

Tenn

esse

e

Texa

sUta

h

Verm

ont

Virgin

ia

Was

hing

ton

Wes

t Virg

inia

Wisc

onsin

0%

5%

10%

15%

20%

25%

30%

35%

40%

l Line indicates 95% confidence interval

6

Mental Health Parity and Addiction Equity Act of 2008 and ACA

• Requires group health insurance plans (those with 50 or more insured employees) that offer coverage for MH/SUD to provide those benefits in a way that is no more restrictive than all other medical and surgical procedures covered by the plan.

• DOES NOT require group health plans to cover MH/SUD benefits.

• Parity extended in 2014 through the Affordable Care Act for plans sold through the State-based and Federal Health Exchanges

7

ESSENTIAL HEALTH BENEFITS (EHB) 10 BENEFIT CATEGORIES

1. Ambulatory patient services

2. Emergency services3. Hospitalization4. Maternity and newborn

care5. Mental health and

substance use disorder services, including behavioral health treatment

6. Prescription drugs7. Rehabilitative and

habilitative services and devices

8. Laboratory services9. Preventive and wellness

services and chronic disease management

10. Pediatric services, including oral and vision care

8

“Integrated Care” Defined

• Integrated Care– the systematic coordination of general

and behavioral healthcare. Integrating mental health, substance abuse, and primary care services…

http://www.integration.samhsa.gov/about-us/what-is-integrated-care

9

Google Search: What is Integrated Healthcare?

“About 639,000 results”

Google search results 8-10-14

10

FOCUS: WORKFORCE CHALLENGES

Worker shortages and distributionMore than one-half of BH workforce is over age 50Between 70 to 90 percent of BH workforce is white Inadequately and inconsistently trained workersEducation/training programs not reflecting current research baseBilling involves increasing licensing & credentialing requirementsHigh levels of turnoverDifficulties recruiting people to field – esp. from minority

communities Inadequate compensationPoorly defined career pathways

11

Meeting the Challenge

• Opportunities for partnerships within the Department of Health and Human Services

• Partnerships and funding to the States, health centers, and providers

• Engaging service providers in policy development and implementation

• Evaluating what is working

12

HRSA Behavioral Health Integration Initiative July 31, 2014

“Secretary Sylvia M. Burwell announced $54.6 million in Affordable Care Act funding to support 221 health centers in 47 states and Puerto Rico to establish or expand behavioral health services for over 450,000 people nationwide. Health centers will use these new funds for efforts such as hiring new mental health professionals, adding mental health and substance use disorder health services, and employing integrated models of primary care.”

http://www.hhs.gov/news/press/2014pres/07/20140731a.html

13

CMS Medicaid Innovation Accelerator Program

Focus Area: Reducing Substance Use Disorders (SUD)• The IAP will develop technical resources to support

innovation through key functions:• Identify and advance new models • Data analytics• Improved quality measurement• State-to-state learning, rapid-cycle improvement, and

federal evaluationhttp://www.medicaid.gov/State-Resource-Center/Innovation-Accelerator-Program/Innovation-Accelerator-Program.html

14

Technical Assistance Center: SAMHSA/HRSA Center for Integrated Health Solutions (CIHS)

In partnership with HHS/Health Resources and Services Administration (HRSA)

• Goal: To promote the planning and development of integrated primary and behavioral health care for those with SMI, addiction disorders and/or individuals with SMI and a co-occurring substance use disorder, whether seen in specialty mental health or primary care safety net provider settings across the country

• Purpose: – To serve as a national training and technical assistance center on the

bidirectional integration of primary and behavioral health care and related workforce development

www.centerforintegratedhealthsolutions.org

15

BUILDING THE WORKFORCE

• $56 M in Now Is the Time (+ $ 11 M)– In collaboration with HRSA– Adds commitment to BH workforce data– Maintains most of FY 2014 increase to

Minority Fellowship Program– Adds commitment to peer/paraprofessional

workforce

16

HRSA/SAMHSA BHWET Grants

• Behavioral Health Workforce Education and Training (BHWET) for Professionals and Paraprofessionals grants

• Expands the mental health and substance abuse workforce serving children, adolescents, and transitional-age youth with or at risk for developing behavioral health disorders.

• $30 million in FY 2014 grant funding, the program will annually provide 12 months of training to about 1,800 professionals and 1,700 paraprofessionals.

• www.hrsa.gov/about/news/2014tables/behavioralhealth/

Role of Providers

Develop partnerships with primary care and other specialty care systems—identify what roles they can play in or as Health Homes (ACA Section 2703)

Improve their infrastructure

● Operations (e.g. billing)

● Electronic health records

● Compliance

Developing a competent workforce including use of peers or recovery coaches

18

Next Steps Providers/Care Systems

• Be at the table in State EHB Benchmark conversation

• Understand the Marketplaces• Translate Eligibility into a Consumer-Friendly

Environment (Coverage-to-Care)• Assure MH/SUD Service Capacity• Promote Ongoing Service Innovation

SAMHSA Workforce Initiative

Leading Change 2.0: Advancing the Behavioral Health of the Nation 2015-2018:SAMHSA’s recently released Strategic Plan for 2015-2018 has added a new Strategic Initiative for Workforce Development to help meet our nation’s ever-increasing demand for behavioral health services.

Four main goals with the workforce initiative

1. Develop and disseminate workforce training and education tools and core competencies.

2. Increase the number of peer practitioners.3. Develop ways to track behavioral health workforce

needs.4. Increase funding for the behavioral health

workforce.

21

Questions?

Thank you!

Contact Information:David Dickinson

SAMHSA Regional Administratordavid.dickinson@samhsa.hhs.gov

206-615-3893