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Peer Support for Substance use Disorders: The Future in Kentucky

Peer Support for Substance use Disorders: The Future in Kentucky. Carol McDaid Capitol Decisions, Inc. October 8, 2013. When are peer recovery support services delivered?. Across the full continuum of the recovery process: Prior to treatment During treatment Doctor’s Office Post treatment

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Peer Support for Substance use Disorders: The Future in Kentucky

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  1. Peer Support for Substance use Disorders: The Future in Kentucky Carol McDaid Capitol Decisions, Inc. October 8, 2013

  2. When are peer recovery support services delivered? • Across the full continuum of the recovery process: • Prior to treatment • During treatment • Doctor’s Office • Post treatment • In lieu of treatment

  3. Where are they delivered today? • Recovery community centers • Faith and community-based organizations • Recovery homes and sober housing • Emergency departments • Addiction and mental health service agencies • Jails and prisons • Probation and parole programs • Drug courts • HIV/AIDs and other health and social service centers • Children, youth, and family service agencies

  4. Where else will they be delivered? • Trauma centers • Primary care practices • Patient-centered medical homes • Federally Qualified Health Centers • Accountable Care Organizations • Community mental health centers • Community-based alternatives to jails and prisons • Schools & colleges

  5. Who is paying for peer recovery services? • Medicaid • State, county & municipal service contracts • Private pay • Federal and state grants • As of May 2008: • 30 states developed criteria for peer specialists1 • 14 states have accessed Medicaid reimbursement for peer-delivered mental health and/or addiction services2 Sources: 1 http://gainscenter.samhsa.gov/peer_resources/pdfs/Davidson_Rowe_Peersupport.pdf 2http://www.dsgonline.com/RTP/2011.weekly/2011.06.09/WH.2011.06.09.html

  6. Why are peer recovery supports critical in the modern health care system? • Population changes • Increase in population diversity & younger cohorts of individuals from low-income families • Hispanic population increased 43% between 2000 and 2010 • Increase in elderly population (87 million by 2050) • Cultural understanding is essential • Managing population health requires community education • Provider shortages • Health system is increasingly complex; peers provide navigation & advocacy to underserved & vulnerable populations • Individuals with behavioral health conditions remain uninsured even with near universal access to insurance • In MA, average number of uninsured is 2%; average rate of uninsured with MH/SUDs is 16%

  7. How can addiction recovery coaches advance the goals of parity & ACA?

  8. ACA & Parity Background • The Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA) present opportunities for recovery coaches regardless of locale • Enroll individuals in exchanges & Medicaid expansion (ME) • Advocacy for coverage & reimbursement of peer recovery support services (PRSS) in state exchange & ME

  9. The Opportunity • Parity & ACA provide opportunities for delivering & receiving peer-provided recovery support services (PRSS) • Approximately 30 m Americans without coverage today expected to receive it under state exchanges or Medicaid Expansion • Medicaid expansion for childless young adults up to 133% of poverty • 11 m of the currently uninsured population below 400% of poverty have MH/SUDs • Specific strategies & tactics are needed to capitalize on this opportunity • How do recovery coaches take advantage? Will we let others capitalize on this opportunity?

  10. Medicaid Expansion & Exchange Enrollment Strategies • When available, use FAVOR’s ACA enrollment training curriculum for peers & volunteers • Arm outreach staff w/the right tools (Medicaid & exchange program manuals, outreach event materials, cell phone etc) • Develop an enrollment plan (who, how many, by when?)

  11. PRSS Advocacy Strategies & Tactics • Develop relationship w/state Medicaid director & meet with him/her to share info & data about recovery supports • Host webinar to educate local advocates on new rights and benefits • Meet with/write to insurance commissioner asking re parity guidance to health plans in state

  12. Use Parity to Include PRSS in Exchange & Medicaid Expansion • Contact CMS if state is not implementing parity • Send consumers to www.parityispersonal.org for information on how to appeal denied claim • Educate exchange & ME decision-makers that MHPAEA requires that PRSS must be included in exchange if other med/surg supports are covered • Seek inclusion of exchange/ME parity audit provision in state law or regs

  13. Questions? Carol McDaid cmcdaid@capitoldecisions.com

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