Maryland’s Public Behavioral Health Care System – Changes on the Horizon

1. Maryland’s Public Behavioral Health Care System – Changes on the Horizon Susan Jenkins October 2013

2. Affordable Care Act (ACA) goal: reduce the number of uninsured • Over 47 million non-elderly Americans were uninsured in 2012.   • Decreasing the number of uninsured is a key goal of the Affordable Care Act (ACA), which will provide Medicaid or subsidized coverage to qualifying individuals with incomes up to 400% of poverty beginning in 2014.

3. The lack of insurance impacts access to health care • One-quarter (25%) of uninsured adults go without needed care each year due to cost. • The uninsured are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases. (Kaiser Foundation)

4. The ACA will expand coverage… • to millions of currently uninsured people through the expansion of Medicaid eligibility and establishment of Health Insurance Marketplaces in 2014, • and also will help people maintain coverage and make private insurance affordable and accessible.

5. Affordable Care Act • Young adults stay on their parents’ health plans to age 26 • No lifetime or annual limits on essential health benefits for children and adults (1/1/2014) • No pre-existing condition exclusions (for adults beginning 1/1/2014) • Expanded Medicaid coverage for former foster youth up to age 26 • Preventive care without co-pays or deductibles • No pre-authorization for ER • Seniors get help with their prescription drugs

6. Maryland has embraced Health Care Reform and the ACA • Governor O’Malley, Lt Governor Brown, Secretary Sharfstein, Deputies Charles Milligan and Gayle Jordan-Randolph, MD have been leaders in Maryland for health care reform and the ACA. • The Maryland Legislature has also been supportive and partnered in these efforts.

7. Triple Aim • Lower Per Capita Costs • Improved Outcomes • Better Patient Experience…

8. Essential Health Benefits • ACA requires all small group and non-group insurance policies sold inside and outside Exchange beginning 1/1/14 to cover minimum set of “essential health benefits (EHB).” • EHB must cover ten benefit categories including mental health & substance use disorder services, prescription drugs; • Health Care Reform Coordinating Council (HCRCC) reviewed the options.

9. Behavioral Health Benefit • Maryland’s largest small group plan will be the State’s benchmark; • GEHA (Government Employees Health Association) is a self-insured, not-for-profit association providing health plans to federal employees. • The federal GEHA behavioral health benefit will be the behavioral health benefit in Maryland’s benchmark plan.

10. www.marylandhealthconnection.gov • Maryland Health Connection is the new marketplace opened October 2013. • Make insurance company comparisons and determine eligibility for financial assistance (tax credits) to reduce the cost of monthly insurance premiums. • A single, streamlined application will determine eligibility for Medicaid or private insurance. • Consumer assistance will also be available through the call center or in-person throughout the state in Local Health Departments, Departments of Social Services and a network of consumer assistance organizations known as “Connector Entities.”

11. Changes Planned To the PBHS • ADAA and MHA to reorganize into a single Behavioral Health Administration – July 1, 2014 • One Administrative Services Organization (ASO) will manage Behavioral Health Administration benefits for Medicaid Recipients and uninsured - July1, 2015 • New integrated Behavioral Health regulations • Accreditation instead of certification by OHCQ based on regulations

12. Outpatient Treatment Services • Services - Assessment, Individual Counseling, Group Counseling, Opioid Maintenance Therapy, Intensive Outpatient • Current: MA patients are paid by MCO • Current: Uninsured patients are paid by grant funds • Current: Provider submits data in SMART • Current: authorizations by MCO (MA Patients) • Current: Provider bills MCO (MA Patients) • Future: Paid by ASO (MA and uninsured) • Future: Provider will submit data to ASO • Future: ASO authorizes services • Future: Provider will bill ASO

13. Residential Treatment Services • Levels III.7 (medically monitored intensive), III.5 (clinically managed high intensity), III.3 (clinically managed medium intensity ),and III.1(halfway house - clinically managed low intensity) • Current: Paid by grant funds • Current: Jurisdiction authorizes service • Current: Provider submits data in SMART • Future: Jurisdiction’s choice - Paid by grant funds OR by ASO • Future: If jurisdiction chooses to have residential service paid by ASO, provider bills ASO • Future: Provider will submit data to ASO and ASO will authorize service • Future: Jurisdiction submits data to ASO

14. Recovery Services Services - Care Coordination, Continuing Care Recovery Checkups, Recovery Housing, Recovery Community Center Activities, Recovery Coaching • Current: Paid by grant funds • Current: Jurisdiction authorizes service • Current: Provider submits data in SMART • Potential: Paid by grant funds • Potential: Provider will submit all data to ASO • Potential: For Care Coordination, Continuing Care, and Recovery Coaching, ASO will authorize service

15. Authorization for Services • The Behavioral Health Administration will establish the requirements for a service • The service provider will provide information to the ASO that allows the ASO to evaluate whether the prospective service recipient meets the established requirements • The ASO will either approve or disapprove the service