Federal Health Policy: Updates and Opportunities for the Substance Use Disorder Field

1. Federal Health Policy:Updates and Opportunities for the Substance Use Disorder Field Dan Belnap Legal Action Center March 28, 2012

2. Legal Action Center • Advocacy for people with addiction histories, criminal records, and HIV/AIDS • Thirty-five year history of policy analysis and advocacy • Federal policy work advocating for the expansion of services and resources for people with addiction histories, criminal records, and HIV/AIDS • Fighting discrimination: eliminating legal and policy barriers in place for people with addiction histories and criminal records • Co-Chair of the Coalition for Whole Health, a coalition of over 100 national, state and local members advocating for strong ACA implementation for MH/SUD

3. What we’ll discuss today • Updates and Next Steps for Our Advocacy • Implementation of the Affordable Care Act (ACA) • Essential Health Benefits • HHS Bulletin • Update on the Coalition for Whole Health’s EHB work • Overview of ongoing implementation of several important ACA provisions • Huge need for our continued collective advocacy

4. Parity and Health Care Reform: A Time of Tremendous Opportunity • Greater understanding of addiction and mental illness as treatable chronic health conditions • Inclusion of SUD and MH prevention, treatment and recovery support services and providers by the broader health care system • Anticipating a dramatic expansion of coverage of SUD and MH care through the new federal parity and health care reform laws (the Affordable Care Act or ACA)

5. Essential Health Benefits • The ACA will require certain health coverage to meet minimum requirements, including benefit requirements, beginning in 2014. • The 10 required categories of service: • While the SUD/MH category itself is important, SUD/MH touches, and must be addressed, in most of the 10 categories

6. Essential Health Benefits (cont’d) • Essential Health Benefits (including SUD and MH) must be offered: • By private insurance plans participating in the health insurance exchanges • By non-grandfathered individual and small group plans outside the exchanges • To newly-eligible Medicaid enrollees, including childless adults

7. Essential Health Benefits (cont’d) • Large group plans and “traditional” Medicaid do not need to meet EHB requirements • EHB will have a direct impact on over 70 million Americans • Where the EHB is required, parity is required • ACA improves on the federal parity law • SUD/MH benefits required and must be provided at parity • Extension to individual and small group plans

8. Essential Health Benefits—who decides the specifics? • The 10 EHB categories are in statute; left to Secretary of HHS to define • December 16th HHS Bulletin: Strong State role, no federal definition of EHB • Secretary allowing States to “benchmark” to one of ten options: • One of the three largest small group plans in the State • One of the three largest FEHBP plans • One of the three largest State-employee plans • The largest HMO in the State • For States that do not choose, largest small group is default

9. Benchmarking Essential Health Benefits—What does this mean? • States will have lots of flexibility to define the EHB • Some range and variability in MH and SUD benefits available through typical employer plans • IOM and Milliman reports found relatively broad coverage of continuum of MH/SUD services in existing plans • EHB must be consistent with parity and nondiscrimination requirements • MH/SUD benefits appear to be protected against being weakened by any substitutions that may be allowed • State-level advocates are in a strong position to influence EHB; advocacy extremely important!

10. Advocacy tools—Coalition for Whole Health Benefit Recommendations • Consensus document as tool for the MH/SUD fields to advocate for strong MH/SUD benefits in the EHB • EHB’s need to address: • Long-term recovery and a chronic care approach • Include prevention, treatment, habilitation and rehabilitation • Prescribed medications when appropriate

11. Coalition for Whole Health Benefit Recommendations (cont’d) • Consensus document includes specific minimum benefits recommendations for MH/SUD across the continuum, including: • Outpatient treatment & Intensive outpatient treatment • Inpatient hospital services • Residential SUD treatment (corresponding to ASAM III) • Prescription drugs (all approved medications for MH/SUD) • Pediatric MH/SUD services • MH/SUD related prevention and wellness services • MH/SUD related chronic disease management services and supports

12. Coalition for Whole Health Benefit Recommendations (cont’d) • Endorsed by well over 100 national, state, and local organizations • Tool to evaluate benchmark plan benefits and advocate for services that may not be included in benchmark • Available at www.coalitionforwholehealth.org

13. Other important ACA implementation activities • Medicaid expansion: • Expansion to everyone below 133% FPL, including childless adults for the first time in most states • Approximately 16 million new enrollees • States will also be deciding benefits for Medicaid expansion • Must meet EHB and parity requirements, similar “benchmarking” process for Medicaid expansion as with EHB • Federal government to pay enhanced match rate for expansion population

14. Other important ACA implementation activities (cont’d) • Health Insurance Exchanges • Competitive State-based marketplaces for small employers and individuals to pool risk and purchase insurance • Plans will have to meet EHB and parity requirements and other consumer protections • Plans will have to maintain a sufficient network of providers, including MH/SUD providers, to ensure all services are accessible without unreasonable delay

15. Other important ACA implementation activities (cont’d) • Inclusion of addiction in integrated care initiatives • Health homes and accountable care organizations • Inclusion of substance use prevention in chronic disease prevention initiatives • Identification of the addiction service workforce as part of the health workforce

16. Protecting SUD Safety Net Funding • Recognition that ACA coverage provisions do not go into effect until 2014 and will take years to fully implement • We don’t yet know exactly which services will be included in the SUD essential health benefit • Huge need for continued strong federal funding for prevention, treatment, recovery supports and research before the ACA is fully implemented and beyond • During this interim period before expansion has occurred • Through implementation of the ACA to cover the services not included and the people who remain uncovered or underinsured

17. Our Advocacy on Strong Safety Net Funding • Advocacy by the national drug and alcohol community • Fighting for highest possible funding for SAMHSA and the continuum • Huge need for a continued push from around the country with Congress and the Obama Administration; www.lac.org • Need to ensure our system of care is strong now and beyond

18. Our Advocacy: Now More Important Than Ever • Continued outreach and education—within and outside of our field • Connecting our work in Washington with implementation efforts around the country • Speaking with one cohesive voice • Finding the best ways to engage our champions • Advocating for the strongest possible SUD and MH benefits through the ACA • Protecting safety net programming • Monitoring implementation and informing our federal partners about successes and non-compliance

19. Questions? Dan Belnap dbelnap@lac.org 202-544-5478 www.lac.org