Transcript Slide 1

NMHU 3rd Annual Alcohol &
Substance Abuse Treatment
Conference
May 12-15, 2014
The Affordable Care Act:
Four Key Strategies
Prevalence of Behavioral Conditions Among Medicaid
Expansion Population: New Mexico
Uninsured Adults Ages 18-64 with Incomes
< 139% of the Federal Poverty Level (New Mexico: 170,472)
20%
18%
Prevalence Rate
16%
National
14%
12%
New
Mexico
10%
8%
I Confidence
6%
Interval
4%
2%
0%
7.0%
4.3%
Serious Mental Illness
NM CI: 2.5% - 7.3%
U.S. CI: 6.3% - 7.7%
5
14.9% 11.2%
14.2% 8.4%
Serious Psychological Substance Use Disorder
Distress
NM CI: 5.4% - 12.9%
NM CI: 6.6% - 18.3% U.S. CI: 13.2% - 15.2%
U.S. CI: 14% - 15.9%
CI = Confidence Interval
Sources: 2008 - 2010 National Survey on Drug Use and Health (Revised March 2012)
2010 American Community Survey
New Mexico Medicaid Expansion
Projections:
• Medicaid Expansion = 170,472
 SMI (4.3%) = 7,330
 SERIOUS PSYCH DISTRESS (11.2%) =
19,093
 SUD (8.4%) = 14,320
 TOTAL = 40,743
Prevalence of Behavioral Conditions Among Health
Insurance Exchange Population: New Mexico
Uninsured Adults Ages 18 - 64 with Incomes Between
133- 399% of the Federal Poverty Level (New Mexico: 157,091)
Prevalence Rate
30%
25%
National
20%
New
Mexico
15%
I Confidence
Interval
10%
5%
0%
6.0%
2.8%
13.3% 6.1%
14.6% 17.6%
Serious Mental Illness Serious Psychological
Substance Use
NM CI: 1.1% - 6.9%
Distress
Disorder
U.S. CI: 5.5% - 6.6%
NM CI: 3.6% - 10.3%
NM CI: 12.1% - 25%
U.S. CI: 12.5% - 14.2% U.S. CI: 13.7% - 15.6%
7
CI = Confidence Interval
Sources: 2008 - 2010 National Survey on Drug Use and Health (Revised March 2012)
2010 American Community Survey
New Mexico Marketplace Exchanges
Projections:
• MARKETPLACE EXCHANGES =
157,091
 SMI (2.8%) = 4,399
 SERIOUS PSYCH DISTRESS (6.1%) =
9,583
 SUD (17.6%) = 27,648
 TOTAL = 41,630
New Mexico Data
Marketplace Plan Selection = 32,062
Medicaid/CHIP Enrollment = 60,378
Total = 92,440
30 % BH Disorders = 27,732 of 82,373
Enrollment Resources
 SAMHSA Enrollment Webpage
o http://www.samhsa.gov/enrollment/
 State Reform Exchange Decisions
o http://www.statereforum.org/node/10222
 Enroll America Best Practices
o http://www.enrollamerica.org/best-practices-institute
 Healthcare.gov
o http://www.healthcare.gov/marketplace/index.html
 HHS Partners Resources
o http://www.cms.gov/Outreach-andEducation/Outreach/HIMarketplace/index.html
SAMHSA HEALTH REFORM TOOLKITS
 http://tiny.cc/CommunityPrevention
 http://tiny.cc/ConsumerPeerFamily
 http://tiny.cc/HomelessServices
 http://tiny.cc/CriminalJustice
 http://tiny.cc/TreatmentProviders
 http://tiny.cc/GettingReady
(GENERAL)
Changing Health Care Environment
 Prevention/Wellness rather than illness
 SA/MH Services are Essential Health Benefit
 Quality rather than Quantity – saving costs
through better care rather than less care
 Inclusive – Goal is to provide access to care
 Public Payers’ Roles changing
 Implications for the Workforce
Opportunities
 ACA – new enrollment and
payment opportunities
 Emerging science
 Healthcare integration
 Parity – MHPAEA Final Rule
 AG’s call for treatment rather
than incarceration for SA
 ↑ understanding of BH role in
health promotion,
prevention, treatment and
costs
 President’s/nation’s attention
to MH issues
o www.mentalhealth.gov
o www.creatingcommunitysolutions.org
DAILY DISASTER OF UNPREVENTED
AND UNTREATED M/SUDs
14
Any MI:
45.9 million
SUD:
23.1 million
Diabetes:
25.8 million
39.2 %
receiving
treatment
11.2 %
receiving
treatment
84 %
receiving
treatment
Heart
Disease: 81.1
million
74.6 %
receiving
screenings
Hypertension:
74.5 million
70.4%
receiving
treatment
Region 6 Profile
State
Capital
Population1
Pop.
Density2
Joint
SUD
Prevalence3
SMI
Prevalence4
Suicide
Rate5
Arkansas
Little Rock
2,915,918
56
Yes
6.94
5.41
15.5
Louisiana
Baton Rouge
4,533,372
104.9
Yes
7.66
3.78
12.3
New Mexico
Santa Fe
2,059,179
17
Yes
9.15
4.51
20.1
Oklahoma
Oklahoma City
3,751,351
54.7
Yes
9.15
5.06
16.5
Texas
Austin
Washington,
DC
25,145,561
96.3
Yes
8.13
3.33
11.7
308,745,538
87.4
N/A
8.5
3.9
12.1
United States
1U.S.
Census 2010 resident population, all ages
Census 2010
3SAMHSA, NSDUH 2010-2011, Table 19. Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 18 or Older (Substance Use Disorder).
4SAMHSA, NSDUH 2010-2011, Table 22. Serious Mental Illness in Past Year among Persons Aged 18 or Older (revised October 2013).
5CDC, National Vital Statistics System-Mortality (NVSS-M) 2010, per 100,000
2U.S.
MENTAL HEALTH & ADDICTION EQUITY
ACT (MHAEPA)
• The Mental Health
Parity and Addiction
Equity Act requires
insurance groups that
offer coverage for
mental health or
substance use
disorders to provide the
same level of benefits
that they do for general
medical treatment. Visit
"Parity" to learn more.
Mental Health Parity and Addiction Equity Act
(MHPAEA)
A group health plan and a health insurance issuer offering
health insurance coverage in the group or individual market
must ensure that
Financial requirements
(such as copays and deductibles)
and
Treatment limitations
(such as visit limits)
applicable to mental health or substance use disorder (MH/SUD)
benefits are no more restrictive than
the predominant requirements or limitations applied to
substantially all medical/surgical benefits.
MHPAEA/ACA: Projected Reach
Individuals who Individuals with
will gain MH,
existing MH and
SUD, or both
SUD benefits who
benefits under
will benefit from
the ACA
federal parity
including
protections
federal parity
protections
Total individuals who
will benefit from
federal parity
protections as a result
of the ACA
Individuals currently
in individual plans
3.9 million
7.1 million
11 million
Individuals currently
in small group plans
1.2 million
23.3 million
24.5 million
Individuals currently
uninsured
27 million
n/a
27 million
Total
32.1 million
30.4 million
62.5 million
*These estimates include individuals and families who are currently enrolled
in grandfathered coverage
2015 BUDGET/WORKFORCE
SAMHSA 2015
PROPOSED BUDGET
PROTECTING THE HEALTH OF CHILDREN
AND COMMUNITIES
Now Is the Time – $130 M (+ $15.0 M)
 $115 M continued from FY 2014
 Science of Changing Social Norms (+ $4 M)
 Peer Professionals (+ $10 M)
 Workforce Data (+ $1.0 M)
STRENGTHENING &
INTEGRATING CARE
Primary Care and Addiction Services
Integration (PCASI) – + $20 M
• Allow addiction treatment providers to offer an array
of physical health and addiction treatment services
• Modeled after Primary/Behavioral Health Care
Integration (PBHCI) program
LEADING CHANGE 2011 – 2014
8 STRATEGIC INITIATIVES
LEADING CHANGE 2.0: 2015 – 2018
• Out for public comment this month
• Will contain 6 initiatives
• Will guide the next 4 years
• Final early fall
SAMHSA OF THE FUTURE – FY 2014 AND BEYOND
SAMHSA’s Strategic
Initiatives 2015 – 2018
SAMHSA’s Strategic
Initiatives 2011 – 2014
1. Prevention
2. Health Care and
Health Systems
Integration
3. Trauma and Justice
4. Recovery Support
5. Health Information
Technology
6. Workforce
Resource
Investment
Policy
Health Financing
Communications
Data
SAMHSA’s
Strategic
Initiatives
Staff
Development
Prevention
Trauma and Justice
Military Families
Recovery Support
Health Reform
Health Information
Technology
7. Data, Outcomes &
Quality
8. Public Awareness &
Support
Business
Operations
1.
2.
3.
4.
5.
6.
SAMHSA’S THEORY OF
CHANGE
EVALUATION
SURVEILLANCE
INNOVATION
Proof of concept
Services
Research
Practice-based
Evidence
TRANSLATION
Implementation
Science
Demonstration
Programs
Curriculum
Development
Policy Development
Financing Models and
Strategies
DISSEMINATION
Technical Assistance
Policy Academies
Practice Registries
Social Media
Publications
Graduate Education
IMPLEMENTATION
Capacity Building
Infrastructure
Development
Policy Change
Workforce Development
Systems Improvement
WIDESCALE
ADOPTION
Medicaid
SAMHSA Block Grants
Medicare
Private Insurance
DOD/VA/DOL/DOJ/ED
ACF/CDC/HRSA/IHS
“NOT YOUR GRANDMOTHER’S
SAMHSA”
• Leadership & Voice – Influencing
Public Policy
• Data & Surveillance
• Practice Improvement
• Grant Making w/ a Designated Purpose
• Regulation/Guidelines
• Public Awareness/Education
Thank you!
Michael Duffy
SAMHSA Regional Administrator-HHS Region VI
(AR, LA, NM, OK, TX)
US Dept. of Health and Human Services
1301 Young Street
Suite 1030
Dallas, Texas 75202
[email protected]
Office: 214-767-0522