STATE BEHAVIORAL HEALTH LEADERSHIP IN A CHANGING HEALTH CARE ENVIRONMENT
-
Upload
galvin-cohen -
Category
Documents
-
view
30 -
download
0
description
Transcript of STATE BEHAVIORAL HEALTH LEADERSHIP IN A CHANGING HEALTH CARE ENVIRONMENT
1
2
STATE BEHAVIORAL HEALTH LEADERSHIP IN A CHANGING HEALTH CARE ENVIRONMENT
Pamela S. Hyde, J.D.SAMHSA Administrator
SAMHSA SSDP Conference Baltimore, MD • July 30, 2012
3
TODAY’S DISCUSSION
4
A PUBLIC HEALTH MODEL FOCUSES ON PEOPLE & COMMUNITIES
People – NOT money, diseases, programs, or authorities• People come with multiple diseases/conditions, social determinants,
cultural backgrounds and beliefs• People come to multiple settings – primary or specialty care, schools,
courts, places of worship, through social media• Healthy productive satisfying lives without disorder or in recovery are the
outcomes we seek
Communities – People w/ common geography, culture, language, beliefs, or characteristics focusing together on common good• Health and disease/disorder occurs and is promoted or prevented in
communities• State/Territorial/Tribal governments can help or be a barrier• Requires collaboration
5
PUBLIC HEALTH MODEL FOR BEHAVIORAL HEALTH
6
MISUNDERSTANDING LEADS TO INSUFFICIENT RESPONSES
7
BEHAVIORAL HEALTH IS NOT A MORAL OR SOCIAL PROBLEM
Social/moral problem context focuses on problems:– Homelessness– Crime/jails– Child welfare problems– School performance or youth behavior problems– Provider/system/institutional/government needs or failures– Public tragedies
Public (and public officials) often misunderstand, blame, discriminate, make moral judgments, exclude• Ambivalence about worth of individuals affected and investment
in prevention/treatment/recovery• Ambivalence about ability to impact “problems” “caused” by
persons with behavioral health needs
8
INTEGRATING INTO HEALTH CARE & COMMUNITY SETTINGS
9
BUDGET - CHALLENGES
10
SAMHSA’S BUDGET FY 2008 – FY 2013
$3,234$3,335
$3,431$3,379 $3,348
$3,152
$3,343
$3,153
$122
$132
$132$132
$129
$165
$129
$20 $88$88
$105
$88
$2,500
$2,700
$2,900
$3,100
$3,300
$3,500
$3,700
FY 2008 Actual
FY 2009 Actual
FY 2010 Actual
FY 2011 Actual
FY 2012 Enacted
FY 2013 President's
Budget
FY 2013 Senate
Committee Mark
FY 2013 House
SubCommittee Mark
Do
llars
in
Mill
ion
s
SAMHSA FY 2008 - FY 2013 Total Program Level$
$3,356 M
$3,466 M
$3,583 M $3, 565 M$3,599 M
$3, 423 M*
#$3,560 M*
$3,153 M
Total Program Level Includes: Budget Authority, PHS Evaluation Funds, and ACA Prevention Funds. FY2012 Enacted amount incorporates the 0.189% recession. *FY2013 also includes $1.5 M estimated for user fees for Extraordinary Data and Publication Requests.
ACA
PHS
BA
11
FY 2013 LIKELY SCENARIOS
President’s Budget, Senate Committee Mark, and House Subcommittee Mark• All signal positions, not decisions
CR Through December or March• How long and how much depends . . .• Likely equal to or less than FY 2012
Sequester Jan 2013 = ~ 7.8 percent ↓ from FY12 • Applied to FY 2013 (enacted or CR)• Exec’s/OMB’s role by September
12
SAMHSA’S FY 2014 PRINCIPLES(IF POSSIBLE . . .)
Maintain ~ Ratio of BG to Discretionary Dollars (~65/35)• Assumptions re health reform impacting need
Maintain Ratio of SA and MH Funding (~ 70/30)
Avoid Terminations/Reductions of Existing Awards
Continue Holistic Approach through Joint Funding
Build Off Innovations from Previous Funding Cycles
Maintain Support for SAMHSA’s Strategic Initiatives; Target Available Funding for Top Priorities
13
HEALTH REFORM - OPPORTUNITIES
14
CHANGING HEALTH CARE ENVIRONMENT
Role of States Increasing
Integration Rather than Silo’d Care – Parity
Prevention and Wellness Rather than Illness
Access to Coverage and Care Rather than Significant Parts of America Uninsured – Parity
Recovery Rather than Chronicity or Disability
Quality Rather than Quantity – Cost Controls Through Better Care Rather than More Care
15
SAMHSA’S HEALTH REFORM PRIORITIES – FY 2012 AND FY 2013Uniform Block Grant Application FYs 2014 & FY 2015
• In Fed Reg for 60-day public comment as of 7-13-12Enrollment PreparationExchanges and Qualified Health PlansParity in Medicaid and Essential BenefitsProvider Capacity Development and WorkforceWork with States and Medicaid
• Health homes, rules/regs, service definitions and evidence, screening, prevention, duals, PBHCI, payment issues
• Parity – MHPAEA/ACA Implementation & CommunicationQuality (NBHQF) and Data (including HIT)
16
IN 2014: MILLIONS MORE AMERICANS WILL HAVE HEALTH COVERAGE OPPORTUNITIES
Currently, 37.9 million are uninsured <400% FPL*
• 18.0 M – Medicaid expansion eligible
• 19.9 M – ACA exchange eligible**
• 11.019 M (29%) – Have BH condition(s) * Source: 2010 NSDUH**Eligible for premium tax credits and not eligible for Medicaid
17
PREVALENCE OF BH CONDITIONS AMONG MEDICAID EXPANSION POP
CI = Confidence IntervalSources: 2008 – 2010 National Survey of Drug Use and Health 2010 American Community Survey
18
PREVALENCE OF BH CONDITIONS AMONG EXCHANGE POPULATION
CI = Confidence IntervalSources: 2008 – 2010 National Survey of Drug Use and Health 2010 American Community Survey
19
FOCUS: ENROLLMENT – PREPARATION
Consumer Enrollment Assistance (AZ, NM, MO, CA, NY, VT, ME, MD)• Outreach/public education• Enrollment/re-determination assistance• Plan comparison and selection• Grievance procedures• Eligibility/enrollment communication materials
Enrollment Data, Best Practices TA, and Toolkits – with CMS & ASPE• Testing new common application• SAMHSA learning collaborative with 7 state stakeholder coalitions
Communication Strategy – Message Testing, Outreach to Stakeholder Groups, Webinars/Training Opportunities
Incorporating Enrollment Requirements into RFAs
SOAR Changes to Address New Environment
20
ESSENTIAL HEALTH BENEFITS (EHB) 10 BENEFIT CATEGORIES
1. Ambulatory patient services
2. Emergency services3. Hospitalization4. Maternity and newborn
care5. Mental health and
substance use disorder services, including behavioral health treatment
6. Prescription drugs7. Rehabilitative and
habilitative services and devices
8. Laboratory services9. Preventive and wellness
services and chronic disease management
10. Pediatric services, including oral and vision care
21
FOCUS: BENCHMARK PLANS
Serves as Reference Plan • Reflecting scope of services and limits offered by a
“typical employer plan” in that state• Parity applies
States Allowed to Select a Single Benchmark Plan:• 1 of 3 largest small group market plans (default), or• 1 of 3 largest state employee plans, or• 1 of 3 largest federal employee plans, or• Largest HMO plan in a state
EHB Mini Rule – Thru 9/30/12 Critical
22
BENCHMARK PLANS
If State Does Not Select, Default To Largest Plan By Enrollment In Largest Product in Small Group Market
Must Include All 10 Essential Health Benefit Categories Regardless What Selected Benchmark Plan Covers/Excludes• Supplement from other plans if category not sufficiently covered• Substitution within categories
Parity Applies in Individual, Small & Large Group Markets• Both MHPAEA and ACA parity requirements• Parity work within HHS and with DOL and Treasury
23
BENCHMARK AND EHB REVIEW
HHS Will Assess Benchmark Process for 2016• State choices in 2012 will remain for two years (2014 & 2015)
Periodically Review and Update EHBs• Difficulties with access due to coverage or cost • Changes in medical evidence or scientific advancement • Market changes • Coverage affordability
SAMHA’s Good and Modern Service Definitions & Assessing the Evidence Process Will Inform
24
QUALIFIED HEALTH PLANS – NETWORK ADEQUACY
Qualified Health Plans (QHPs) • Offered through affordable health exchanges (marketplaces)• State choice to set up exchange or use federally facilitated
exchange (FFE)
QHPs’ Networks – Providers Sufficient In Number/Types To Assure Services Accessible w/o Unreasonable Delay• Encourages QHPs to provide sufficient access to broad range
of MH/SUD services, particularly in low-income & underserved communities
• Highlights MH/SUD providers – must be sufficient providers available to deliver!
25
PROVIDERS ACCEPTING HEALTH INSURANCE PAYMENTS*
Inpatient – 95 percent
Outpatient – 68 percent• Primary MH plus some SA – 85 percent
• Primary SA (w/ none or some MH) – 56 percent
• Residential SA – 54 percent
• Other (e.g., Homeless Shelters, Social Services Agencies) – 37 percent
*Source: NSATSS
26
SOURCE OF FUNDS FOR CMHCs*
State/County Indigent Funds – 43 percent• NOTE: State MH ↓$5 B in last 5 years; SA ↓$2-3 B
Medicaid – 37 percent
Private health insurance – 6 percent
Self-pay – 6 percent
*Source: 2011 National Council Survey
27
HEALTH REFORM RESOURCES
http://www.samhsa.gov/HealthReform/• General information about health reform and BH
http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html• Information re state-by-state exchange funding & plans
http://cciio.cms.gov/resources/other/index.html#hie • State Exchange Blueprint
http://cciio.cms.gov/resources/regulations/index.html#hie• States three largest small group plans
28
NEW KIND OF LEADERSHIP – CHALLENGES & OPPORTUNITIESNew PartnersDifferent PoliciesCollaborative PracticeMultiple Party StructuresInfluence v DirectionFunding Capacity v Funding Integrated Service DeliveryBG – State MH & SA Authorities Roles
• Changing not declining