Healthcare Reform Impact The Road Ahead

2. Healthcare Reform ImpactThe Road Ahead John O’Brien Senior Advisor on Healthcare Financing

3. What’s Been Done So Far? Approaching 270 Days Since Affordable Care Act was passed. Changes have focused on: Significant Program Changes and Demonstration Projects for Medicaid Recipients Major Insurance Reform

4. What’s Been Done So Far? What Changes Have Affected Publicly Insured Individuals? States can receive federal matching funds now for covering low-income individuals and families 1M “donut hole” checks to Medicare individuals Round 2 of Money Follows the Person—heavy focus on behavioral health Health Homes for Individuals with Chronic Conditions

5. What’s Been Done So Far? What Changes Have Affected Publicly Insured Individuals? Medicaid 1915i Redux—very important changes Prevention Trust Funds Awarded Expansion of the number of Community Health Centers—serving 20 million more individuals Loan forgiveness programs for primary care, nurses and even some behavioral health professionals Increased payments to rural health providers

6. What’s Been Done So Far? Major Changes For Individuals Who Are Insured: Extending coverage to young adults Providing free preventive care Ability to appeal coverage determinations No lifetime limits on benefits Prohibiting pre-existing coverage for children Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers Holding insurance companies accountable for unreasonable rate hikes

7. Affordable Care Act Major Drivers More people will have insurance coverage Medicaid will play a bigger role in MH/SUD than ever before Focus on primary care and coordination with specialty care Major emphasis on home and community based services and less reliance on institutional care Preventing diseases and promoting wellness is a huge theme Outcomes: improving the experience of care, improving the health of the population and reducing costs

8. Impact of Affordable Care Act Impact on Coverage 61% of the individuals served by SSAs have no insurance Expect that 90-95% of these individuals will have OPPORTUNITY to be covered They will be expected to enroll in Medicaid/ Insurance Exchanges

9. Coverage Enrollment 32 million individuals—many are single males Skepticism—many haven’t been enrolled—historical message that you will never be covered Penalties for not enrolling may not be a powerful stick Challenges—doors to enrollment and challenging enrollment processes Churning

10. What Do We Know About the Newly Covered? Individuals Near the Federal Poverty Level—More diverse group than we think 40% under the age of 29 56% are employed or living with their families Conditions are more acute when they present Care is more costly Source: Center on Budget and Policy Priorities

11. What Do We Know About the Newly Covered? Source: Center on Budget and Policy Priorities

12. What Do We Know About Service Coverage? Timing—Decisions about coverage are not immediate Some sense of categories (Exchanges) Mental health and substance abuse services Rehabilitation and habilitation services Pharmacy Preventive and wellness services This will impact what is purchased through block grant

13. SAPTBG Treatment

14. Block Grants 2010 Addendum—focus on State’s HCR readiness 2011—Proposed Changes to BG Application and regulations Proposed needs assessment for uninsured Planning for FY 2014 Implementation Joint Planning Efforts with MH States Enhancing/Beginning Service Management Efforts Use of technology for service delivery Greater Accountability— More specific information on what is purchased through BG dollars Performance strategies that mirror National Quality Strategies (1/1/2011) 2014 and beyond Services that are not covered by Medicaid/insurance Individuals that are not covered by 3rd party insurance Other (TBD)

15. Provider Plumbing Almost 1/3 of the SAPT do not have experience with 3rd party billing. Less than 10% of all BH providers have a EHR that is nationally certified Few have working agreements with health centers

16. Provider Plumbing National Initiative This Year—Four large trade associations (SAAS, Niatx/NCCBH/NACHC) Billing EHRs Compliance Access

17. Primary Care And Coordination Individuals with SUD/SMI have 2 or more chronic health conditions Barriers include stigma, lack of cross-discipline training, and access to primary care services Have elevated (and often undiagnosed) rates of: hypertension, diabetes, obesity cardiovascular disease Community-based behavioral health providers are unlikely to have formalized partnerships with primary care providers

18. Importance of Integrated Care Focus on coordination between primary care and specialty care: Significant enhancements to primary care Workforce enhancements Increased funding to SAMHSA, HRSA and IHS Bi-directional MH/SUD in primary care Primary care in MH/SUD settings Services and technical assistance Pharmacy opportunities through partnering (340b program

19. Impact of Affordable Care Act Health Homes Focus on chronic conditions (or at risk) Start date: 4 months and counting Medicaid state plan 90% match initially—big incentives for states Several new services: Comprehensive Care Management Care Coordination and Health Promotion Patient and Family Support Comprehensive Transitional Care Referral to Community and Social Support Services

20. Prevention $100 million in grants for public health and prevention priorities $30 million in new resources to support the National HIV/AIDS Strategy $26.2 million to expand primary care to individuals with behavioral health disorders No cost sharing for preventive services for some plans

21. So What Should We Do? Many provisions are still needing further clarity (regulations, SMDs, Grants) Some opportunities now Three years + until some of the major provisions Information overload Economic challenges continue

22. Understand The Key Concepts 22 • Healthcare Exchanges • Health Information Exchanges • High Risk Pools • Benchmark Plans • Essential Benefits

23. What Else Should We Be Doing? Stay Excited Stay Informed Get and Stay Involved Innovate