the affordable care act, integration, and the addiction workforce: challenges and opportunities
DESCRIPTION
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). - PowerPoint PPT PresentationTRANSCRIPT
The Affordable Care Act, Integration, and the Addiction Workforce:Challenges and Opportunities
David DickinsonSAMHSA Regional Administrator
DHHS Region X
NAADAC 2014 Annual ConferenceSeattle, WA September 29, 2014
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ACA and Washington State(as of April 2014)
• 163,207 individuals selected a Marketplace plan between October 1, 2013 and March 31, 2014
• 420,188 Washington 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
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STATE PREVALENCE OF SUD AMONG MEDICAID EXPANSION POPULATION
l Line indicates 95% confidence interval
Alabama
Arizona
California
Connecticu
t
Distric
t of C
olumbia
GeorgiaIdaho
Indiana
Kansas
Louisi
ana
Maryland
Michigan
Mississ
ippi
Montana
Nevada
New Jerse
y
New York
North Dako
ta
Oklahoma
Pennsylva
nia
South Carolina
Tennessee
Utah
Virginia
West
Virginia
Wyo
ming0%
10%
20%
30%
40%
50%
60%
5
STATE PREVALENCE OF SUD AMONG EXCHANGE POPULATION
Alaba
ma
Alask
a
Arizon
a
Arkan
sas
Califo
rnia
Conne
cticu
t
Delaw
are
Flor
ida
Georg
ia
Idah
o
Illino
is
Indi
ana
Iowa
Kansa
s
Kentu
cky
Loui
siana
Mai
ne
Mar
yland
Mich
igan
Miss
issip
pi
Miss
ouri
Mon
tana
Nevad
a
New H
amps
hire
New Je
rsey
New M
exico
New Y
ork
North
Car
olin
aOhi
o
Oklaho
ma
Orego
n
Penns
ylvan
ia
South
Car
olin
a
Tenn
esse
e
Texa
sUta
h
Verm
ont
Virgin
ia
Was
hing
ton
Wes
t Virg
inia
Wisc
onsin
0%
5%
10%
15%
20%
25%
30%
35%
40%
l Line indicates 95% confidence interval
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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 Federal Health Exchanges
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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
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“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
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Google Search: What is Integrated Healthcare?
“About 639,000 results”
Google search results 8-10-14
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FOCUS: WORKFORCE CHALLENGES
Worker shortages and distributionMore than one-half of BH workforce is over age 50Between 70 to 90 percent of BH workforce is white Inadequately and inconsistently trained workersEducation/training programs not reflecting current research baseBilling involves increasing licensing & credentialing requirementsHigh levels of turnoverDifficulties recruiting people to field – esp. from minority
communities Inadequate compensationPoorly defined career pathways
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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
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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
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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 evaluationhttp://www.medicaid.gov/State-Resource-Center/Innovation-Accelerator-Program/Innovation-Accelerator-Program.html
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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, addiction disorders 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
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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
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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/
Role of Providers
Develop partnerships with primary care and other specialty care systems—identify what roles they can play in or as Health Homes (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
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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
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.
Four main goals with the workforce initiative
1. Develop and disseminate workforce training and education tools and core competencies.
2. Increase the number of peer practitioners.3. Develop ways to track behavioral health workforce
needs.4. Increase funding for the behavioral health
workforce.
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Questions?
Thank you!
Contact Information:David Dickinson
SAMHSA Regional [email protected]
206-615-3893