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

The Affordable Care Act, Integration, and the Addiction Workforce: Challenges and Opportunities. David Dickinson SAMHSA Regional Administrator DHHS Region X NAADAC 2014 Annual Conference Seattle, WA September 29, 2014. ACA and Washington State (as of April 2014).

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

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  1. The Affordable Care Act, Integration, and the Addiction Workforce:Challenges and Opportunities David Dickinson SAMHSA Regional Administrator DHHS Region X NAADAC 2014 Annual Conference Seattle, WA September 29, 2014

  2. ACA and Washington State(as of April 2014) • 163,207 individuals selected a Marketplace plan between October 1, 2013 and March 31, 2014 • 420,188Washington 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

  3. STATE PREVALENCE OF SUD AMONG MEDICAID EXPANSION POPULATION l Line indicates 95% confidence interval

  4. STATE PREVALENCE OF SUD AMONG EXCHANGE POPULATION lLine indicates 95% confidence interval

  5. 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 FederalHealth Exchanges

  6. ESSENTIAL HEALTH BENEFITS (EHB) 10 BENEFIT CATEGORIES • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care

  7. “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

  8. Google Search: What is Integrated Healthcare? “About 639,000 results” Google search results 8-10-14

  9. FOCUS: WORKFORCE CHALLENGES Worker shortages and distribution More than one-half of BH workforce is over age 50 Between 70 to 90 percent of BH workforce is white Inadequately and inconsistently trained workers Education/training programs not reflecting current research base Billing involves increasing licensing & credentialing requirements High levels of turnover Difficulties recruiting people to field – esp. from minority communities Inadequate compensation Poorly defined career pathways

  10. 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

  11. 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

  12. 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 evaluation http://www.medicaid.gov/State-Resource-Center/Innovation-Accelerator-Program/Innovation-Accelerator-Program.html

  13. 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, addictiondisorders 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

  14. 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

  15. 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/

  16. Role of Providers Develop partnerships with primary care and other specialty care systems—identify what roles they can play in or as HealthHomes (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

  17. 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

  18. 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.

  19. Four main goals with the workforce initiative • Develop and disseminate workforce training and education tools and core competencies. • Increase the number of peer practitioners. • Develop ways to track behavioral health workforce needs. • Increase funding for the behavioral health workforce.

  20. Questions? Thank you! Contact Information: David Dickinson SAMHSA Regional Administrator david.dickinson@samhsa.hhs.gov 206-615-3893

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