Transcript Drug Crisis on LI: Current Challenges and Future Solutions

Nassau County Heroin Treatment Task Force
Tracie M. Gardner
Director of NYS Policy
December 7, 2012
1
Legal Action Center

 Legal and Policy Advocacy for people with addiction
histories, criminal records, and HIV/AIDS
 Fighting discrimination
 Advocating for the expansion of services and
resources
 Co-Chair on national level of the Coalition for Whole
Health, over 100 national, state and local members
advocating for strong ACA implementation for
MH/SUD. H
 Helped to create NY Coalition for Whole Health
2
Parity and Health Care Reform: A
Time of Tremendous Opportunity

 Landmark victories in health coverage for substance
use disorders and mental health
 Mental Health Parity and Addiction Equity Act
prohibits discrimination
 The Affordable Care Act (ACA) aims to expand SUD
care dramatically by requiring coverage at parity in
both health insurance exchanges and Medicaid
expansion
3
Essential Health Benefits

 The 10 required categories of service:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Ambulatory Services
Prescription Drugs
Emergency Services
Rehabilitative and Habilitative Services and
Devices
Maternity and Newborn Care
Laboratory Services
Mental Health and Substance Use Disorder
Services
Preventive & Wellness Services and Chronic
Disease Management
Hospitalization
Pediatric Services
4
Essential Health Benefits

 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
5
Essential Health Benefits—who
decides the specifics?

 The 10 EHB categories are in statute: HHS giving
states strong role with no federal EHB definition
 For States that do not choose, largest small group is
default
 BUT states must ensure parity!
 So: States will have lots of flexibility, But must
include SUD at parity, But will have lots of flexibility
6
NY chose Oxford as its benchmark
plan

 Advocacy extremely important to take advantage of
this extraordinary opportunity:
1. Evaluate the benchmark plan
2. Ensure compliance with Parity
3. Identify what is not included
7
NY chose Oxford as its benchmark
plan

 We need to ensure that NY’s essential health benefit
addresses:
 Long-term recovery and a chronic care approach
 Include full continuum of prevention, treatment,
habilitation and rehabilitation
 Residential treatment when appropriate
 Prescribed medications when appropriate, including all
approved medications for SUD/MH
8
Other Issues Related to Health Care
reform: Medicaid expansion

 Expansion to everyone below 133% FPL, including
childless adults for the first time in most states
 Approximately 16 million new enrollees
 Enormous opportunity to close treatment gap: Huge
Opportunity for Criminal Justice population
 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: eventually 90% in all states
9
Other Issues Related to Health Care
reform: 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 an adequate network of
providers, including SUD/MH providers, to ensure
all services are accessible without unreasonable
delay
10
Important ACA Implementation
activities

 There are several provisions in the proposed rule on
Essential Health Benefits that we like, including the
following:
 The proposed regulations make clear that the requirements
of the Mental Health Parity and Addiction Equity Act apply
in the context of the EHB.
 We support allowing states the flexibility to choose the base
benchmark option that works best for them while still
retaining the state mandates that were in place at the end of
last year, as state benefit mandates are important to provide
stronger protections to consumers.
 We support expanding the number of prescription drugs
that the EHB will offer to include what will likely be a
wider range of covered medications.
11
Important ACA Implementation
activities

 We'll be finishing the comments for CWH in next
week or so and then collecting signatures from as
many groups as possible and submitting them to
HHS plus urging as many as possible to submit their
own similar comments.
12
Other important ACA
implementation activities

 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
13
Protecting SUD Safety Net Funding

 Recognition that ACA coverage provisions do not go
into effect until 2014 and will take years to fully
implement
 Likely some SUD services will not be covered in
some states and not everyone in need will be
insured: especially true for criminal justice system
 Huge need for continued strong federal funding
before the ACA is fully implemented and beyond
 Need strong and united advocacy in Washington
and states
14
Parity Requirements

 Insurers are prohibited from refusing to cover SUD
treatment that they cover for other medical/surgical
conditions
 Discrimination in quantitative and non quantitative
limitations PROHIBITED
 Insurers are prohibited from providing poorer coverage
for SUD than they provide for other medical/surgical
conditions:
 Insurers cannot charge more or allow fewer visits for MAT
than comparable medical/surgical conditions, and cannot
use more restrictive utilization review, managed care, etc.
15
Eliminate Discrimination

 Danger of discrimination by insurers: Refusal to
cover assessments or treatment ordered by court or
other CJ agency
16
Other important developments
(outside of ACA and parity):

 Meaningful Use—Incentivizing EHR systems to
incorporate our data
On November 7, 2012 The Office of the National Coordinator for
Health IT (ONC), released a Request for Comments (RFC)
regarding the Stage 3 Definition of Meaningful Use of Electronic
Health Records (EHRs). There are a number of topics within this
RFC that are of importance to the behavioral health community
including consent management in electronic health information
exchange and access to prescription drug monitoring program
data http://www.healthit.gov/sites/default/files/hitpc_stage3_rfc_final.pdf
17
Other important developments
(outside of ACA and parity):

 BHOs at the MRT Behavioral Health Subcommittee
 October 18, 2012 Meeting
http://www.health.ny.gov/health_care/medicaid/redesign/docs/bh
_bene_man_care_ppt.pdf
 Behavioral Health Subcommittee recommendations
• Managed care approaches using risk-bearing SNPs and/or BHOs
should be developed. In NYC, full-benefit SNPs should be developed
to include mental health, physical health, and substance abuse
populations.
• SNPs/BHOs should be given responsibilities to pay for inpatient care
at State psychiatric hospitals and to coordinate discharge planning.
This will help reduce incentive for BHOs/SNPs to institutionalize
people in State psychiatric hospitals.
• Advance the core principle that manage care approaches for people
with behavioral health care needs should assist enrollees in recovery
and in functioning in meaningful life roles
18