Staying Informed: Trends in the Addiction Profession

1. Staying Informed: Trends in the Addiction Profession Christopher C. Campbell, NAADAC Director of Government Relations Donald P. Osborn, NAADAC President Shirley Beckett Mikell, NAADAC Director of Certification and Education

2. Presented By

3. Obtaining CE Credit • The education delivered in this webinar is FREE to all professionals. • 2 CEs are FREE to NAADAC members and AccuCare subscribers who attend this webinar. Non-members of NAADAC or non-subscribers of AccuCare receive 2 CEs for $25. • If you wish to receive CE credit, you MUST download, complete and submit the “CE Quiz” that is located at: • www.myaccucare.com/webinars • www.naadac.org/education • A CE certificate will be emailed to you within 30 days. • Successfully passing the “CE Quiz” is the ONLY way to receive a CE certificate.

4. Webinar Objectives • Learn about the Affordable Care Act (ACA) and how it impacts the addiction profession; • Learn about the new national scopes of practice for the addiction profession; and • Understand the importance of maintaining your license or credential. Question and Answer session at the end of the program.

5. The Affordable Care Act (ACA): What It Means for the Addiction Profession Christopher Campbell NAADAC Director of Government Relations

6. Affordable Care Act The new health reform law, signed by President Obama in March 2010, significantly enhances access to healthcare, including prevention and treatment services for substance use disorders.

7. The Affordable Care Act (ACA): What It Means for the Addiction Profession • The passage of the Patient Protection and Affordable Care Act (ACA) ensures that the role of behavioral health in the overall healthcare system will change • Now, it is more important than ever to know how healthcare reform will affect your role and the role of States, behavioral healthcare providers, and consumers

8. The Affordable Care Act • Key points to keep in mind: • The work is really just beginning • Going to learn as we go • Keep an eye on your state (more later) • Need to continue advocacy efforts in order to assure beneficial programs are funded year in and year out!

9. Background • In 2008, 23.1 million Americans age 12 and older needed treatment for a substance use problem, and yet only 2.3 million – one in ten – received care at a specialty treatment center • Many of those who do not receive, but could benefit from, treatment do not have health insurance or other means to pay for it • By helping more people get the care they need, the ACA, when fully implemented in 2014, will go a long way toward closing the “treatment gap”

10. The Affordable Care Act: Coverage Expansion The Affordable Care Act (ACA), signed into law by President Obama in March 2010, expands health insurance coverage to 32 million Americans, guaranteeing that 95 percent of Americans will be covered. • Expands Medicaid for all individuals under 133% of the federal poverty level • Creates State Health Insurance Exchanges to help newly insured and those with individual and small group coverage to purchase affordable policies (large buying club) • Provides credits & subsidies up to 400% of the federal poverty level to help individuals and families purchase insurance

11. The Affordable Care Act • Under the new law, services such as screening, early intervention, treatment, and recovery support for patients with substance use disorders will be provided in the same manner and in the same, primary care settings as services for any other illness • The change will bring needed help to many as it also increases awareness that drug dependence is a chronic, treatable disease

12. In 2014: 32 Million More Americans Will Be Covered HIEs/ Subsidies Commercial Insurance Medicaid ~5m SUDs 6-10 Million with M/SUDs

13. The Affordable Care Act • Of the 32 million currently uninsured Americans who will receive health insurance under the ACA, about 5 million meet medical diagnostic criteria for a substance use disorder (6-10 Million with M/SUDs ) • These Americans will receive insurance coverage to help pay for substance use treatment

14. The Affordable Care Act Insurers will no longer be able to deny coverage based on pre-existing medical conditions, such as substance use disorders.

15. The Affordable Care Act • Individuals and small businesses will have access to affordable coverage through a new competitive private health insurance market through state-based Health Insurance Exchanges • Plans offered through the Exchanges are required to cover mental health and substance use disorder services and must meet the “parity” requirements of the Wellstone-Domenici Mental Health Parity Act of 2008

16. The Affordable Care Act • In 2014, Medicaid eligibility will be expanded for families or individuals with incomes up to 133 percent of Federal poverty guidelines. Many newly eligible beneficiaries will receive substance use services • Participation in Medicaid will help more patients gain access to traditional healthcare benefits, such as medications and behavioral therapies in the treatment of addiction

17. How Do These Numbers Break Down? By 2014: • 6.3 million individuals newly covered by Medicaid will be in need of behavioral health services • 4.2 million individuals newly covered by private insurance will be in need of behavioral health services • About 5 million will meet medical diagnostic criteria for a substance use disorder • $30 billion in Medicaid funding annually for substance abuse services • $7 billion annually in private healthcare contributions for substance abuse services

18. Impact of Affordable Care Act • More people (approx. 32 million) will have insurance coverage • Demand will rise for qualified and well-trained addiction professionals • Medicaid will play a bigger role in paying for substance use treatment services • Focus on primary care & coordination with specialty care • Major emphasis on home & community-based services; less reliance on institutional care • Theme: preventing diseases & promoting wellness • Focus on quality rather than quantity of care

19. What Does This Mean for the Addiction Profession? How can the addiction workforce meet this new demand for services? • Integration of services with other professionals who are trained and educated in SUDs treatment • Help from the Department of Labor (DOL) • SUD Counseling is now a “distressed profession” • (DOL) is working with ONDCP on new effort that would recruit and train 60,000 new counselors over the next decade • Would require $500 million over 4 years, which ONDCP is highly supportive of • But…the budget is an issue…

20. Integration • A major change for the workforce will come in the form of primary care/behavioral health integration • There is a big push to integrate more services into primary care settings (i.e., Primary Care/BH Integration), and this includes substance use disorder treatment and prevention • As a result, primary care settings may be seeking to have counselors on staff • Also, treatment programs should expect an increase in referrals from these primary care settings

21. Integration • It will be incumbent on the professionals in these fields to collaborate, and ideally work together to develop a clinical model of best practices • This will include developing integration budgets, and designing implementation plans • In short, the profession will need to be proactive

22. Workforce Development • The ACA establishes a National Prevention Council, led by the Surgeon General, with substance use disorders as a national priority for the Council’s report to Congress (ONDCP will serve as a member of the Council) • Mental health and behavioral health are listed as high priority areas in the new law’s National Workforce Commission section

23. Workforce Development In addition, the ACA provides: • Funding for residencies for behavioral health included with other disciplines • Loan repayment programs • Push towards more national certification standards • Push towards re-licensure and re-certification

24. Workforce Development Title V of the ACA establishes several new workforce development programs and defines which health professionals are eligible for such programs.

25. Workforce Development Title V of ACA provides funding for scholarships and loan repayment programs, for certain healthcare professionals, including substance abuse prevention and treatment providers, in the areas of the country that need them most, such as rural areas and inner cities.

26. Workforce Development • Certain substance abuse counselors may qualify for these programs under the definition of “mental health service professionals” as defined in the ACA: “MENTAL HEALTH SERVICE PROFESSIONAL.— The term ‘mental health service professional’ means an individual with a graduate or postgraduate degree from an accredited institution of higher education in psychiatry, psychology, school psychology, behavioral pediatrics, psychiatric nursing, social work, school social work, substance abuse disorder prevention and treatment, marriage and family counseling, school counseling, or professional counseling.”

27. Workforce Development • NOTE: The definition of “Mental Health Professional” applies only to Title V programs in the ACA. It extends no further • The federal government does not- and will not- dictate the education or credentials for a civilian profession • Professionals who meet these requirements can qualify for loan repayment programs established by the legislation • It is important to note that the masters degree/no master’s degree issue only applies to one’s ability to qualify for programs under Title V of the ACA. The ability to practice one’s profession does not hinge on this distinction • States will continue to determine who may qualify to practice (i.e., licensure or certification)

28. Workforce Development • For Medicaid reimbursement, the Center for Medicare & Medicaid Services defers to states to define qualified providers • The state sends its guidelines to the Federal Center for Medicare Services, which are almost always accepted without question or review • State guidelines are more important than ever, as federal reimbursement will go to the professionals that the state recognizes as qualified to provide services • The federal government has not set any standards of practice for substance use disorder counselors, nor will they

29. Standards In short… licensure, and in many states certification, is more important than ever, because recognition by the state as to who is recognized as a substance use treatment and prevention professional will almost certainly play a role in who may provide services that are reimbursed by the federal government

30. The Affordable Care Act • It’s an ongoing process • The state still plays a critical role, and the federal role, in terms of the profession, is not as large as you think • Be ready to work with others in the health community on integration of services

31. How to Get Involved in ACA Implementation at the State Level • When the Affordable Care Act is fully implemented in 2014, individuals and small businesses will have access to health care coverage through a new competitive private health insurance market – state-based Health Insurance Exchanges • States are already taking their first steps toward 2014 when Health Insurance Exchanges will be operational

32. How to Get Involved in ACA Implementation at the State Level • Many of those activities have been funded by the $49 million in Exchange planning grants awarded by the U.S. Department of Health and Human Services (HHS) in July of 2010 • States applied to use those grants for a number of important planning activities, including research to understand their insurance markets, efforts to obtain the legislative authority to create Exchanges, and steps to establishing the governing structures of Exchanges

33. How to Get Involved in ACA Implementation at the State Level • It is critical that as your state moves forward with the planning and implementation of its Health Insurance Exchange in 2014, that your Association be “at the table,” either by connecting with the organization in your state charged with HIE implementation, or with your Single State Authority (SSA) • These organizations need to hear from the addiction professionals in their states

34. How to Get Involved in ACA Implementation at the State Level • Resources – NAADAC has the following resources available on the web site (www.naadac.org) to assist in your efforts: • State Health Insurance Exchange Contact Information, and • Directory of Single State Agencies (SSA) for Substance Abuse Services

35. How to Get Involved in ACA Implementation at the State Level • NAADAC encourages you to use these resources to connect with your state’s HIE and/or SSA to see what you can learn, how you submit your recommendations as an Association, and how you can advocate on behalf of the addiction profession in your state

36. Health Information Technology (HIT) and the ACA • Health information technology is essential to the transformation of the health care delivery system and the promotion of preventive care and patient self-care • Both the American Recovery and Reinvestment Act Affordable Care Act contain incentives for providers to adopt Electronic Health Records (EHRs) and will drive integration of services, allowing for greater benefits from and need for the adoption of HIT

37. Health Information Technology (HIT) Some facts: • Of 175 substance abuse treatment programs surveyed, 20 percent had no information systems, e-mail, or even voicemail1 • On average, information technology (IT) spending in behavioral health care and human services organizations represents 1.8 percent of total operating budgets—compared with 3.5 percent of the total operating budgets for general health care services2 • Fewer than half of behavioral health and human services providers possess fully implemented clinical electronic record systems2 1 McLellan, A. T., Carise, D., & Kleber, H. D. (2003). Can the national addiction treatment infrastructure support the public’s demand for quality care? Journal of Substance Abuse Treatment, 25, 117–121. 2 Centerstone Research Institute. (2009, June). Behavioral Health/Human Services Information Systems survey. National Council for Community Behavioral Health Care. Retrieved March 25, 2011, from http://www.thenationalcouncil.org/galleries/policy-file/HIT%20Joint%20Survey%20Exec%20Summary.pdf

38. Health Information Technology (HIT) • According to HHS Secretary Kathleen Sebelius, “Electronic health records will provide major technological innovation to our current health care system by allowing doctors to work together to make sure patients get the right care at the right time.” • She has described patient privacy in HIT as “our top priority.”

39. Health Information Technology (HIT) and SAMHSA • In the past, the specialty behavioral health system has often operated independently from the broader health system and differed in the type and scope of information technology used • SAMHSA is working to increase access to HIT so that Americans with behavioral health conditions can benefit from these innovations (one of SAMHSA’s Eight Initiatives)

40. Health Information Technology (HIT) and SAMHSA SAMHSA is focusing on HIT in general and EHRs specifically to ensure that behavioral health is integrated in to the Nation’s broader health system

41. Health Information Technology (HIT) and the Workforce • Generalized adoption of behavioral health HIT requires the involvement of the behavioral health workforce • Not only must the various treatment settings addressing substance use disorders—such as substance use disorder treatment programs—implement EHR systems, their staff must be trained to function within an EHR environment and to adapt to HIT

42. Health Information Technology and HITECH • Included in ARRA legislation passed in 2009 is the Health Information Technology for Economic and Clinical Health (HITECH) Act, also known as HITECH • HITECH provides funding to establish programs to improve health care quality, safety and efficiency through promotion of HIT and private and secure health information exchange • Medicare and Medicaid (CMS) to offer incentive payments for “meaningful use” of certified EHR technology

43. What is “Meaningful Use?” Centers of Medicare and Medicaid (CMS) issued final regs in July 2010: • Defined the meaningful use requirements (objectives) that providers must meet through use of certified EHR technology in order to qualify for the payments  • Identified the standard criteria for the certification of EHR technology (so eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions to meet meaningful use)

44. What are CMS Incentive Programs for Meaningful Use?

45. Who is Eligible for CMS Incentives?

46. Do I Have to Adopt the Use of EHRs? • No penalty – the incentive program is voluntary • Medicare may adjust payments in 2015 • Medicaid will not adjust any payments

47. What About Behavioral Health Treatment? • Currently incentives contained in HITECH do not apply to most behavioral health, including SUD professionals, unless certain EPs (physicians, nurse) are on staff • However……

48. Behavioral Health Information Technology Act of 2011 • On March 10th, Senator Sheldon Whitehouse (D-RI) introduced S. 539, the Behavioral Health Information Technology Act of 2011 • Bill would extend health information technology assistance included in the HITECH Act to behavioral health, mental health, and substance abuse professionals and facilities • Similar to legislation introduced last year by Reps. Kennedy/Murphy

49. The Future of Education for Addiction Professionals Don Osborn, MAC, ICAC, CCS President of NAADAC

50. Where We Are Now Addictions Counseling (AC) lacks a standardized curriculum Few programs exist beyond Associates Degrees Existing programs lack consistency of hours, content, or learning outcomes