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WHAT IS AHEAD? The Changing Environment for Substance Use Disorder Services.

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Presentation on theme: "WHAT IS AHEAD? The Changing Environment for Substance Use Disorder Services."— Presentation transcript:

1 WHAT IS AHEAD? The Changing Environment for Substance Use Disorder Services

2 Policy Impacts Affordable Care Act (healthcare reform) Wellstone/Domenici Parity Act SAMHSA/ONDCP Leadership Direction Public Funding Environments (Fed & TX)

3 Affordable Care Act (healthcare reform) Passed in March 2010- fully in effect 2014 Includes substance use disorder & mental health (SUD/MH) services as part of essential benefit package in exchange plan Requires that all plans comply with the Wellstone/Domenici Parity Act in providing SUD/MH benefits in the same way as all other covered medical and surgical benefits.

4 Expands Medicaid eligibility for all Americans up to 133% of federal poverty level; both male & female custodial & non-custodial eligible Includes SUD and MH prevention strategies and efforts in the bill’s chronic disease initiatives. Four strategic directions of the National Prevention Strategy includes Preventing Drug Abuse and excessive Alcohol Use as a priority Affordable Care Act (healthcare reform)

5 Wellstone/Domenici Parity Act The law requires that any group health plan that covers more than 50 employees and offers mental health and/or substance use disorders coverage must provide that coverage with no greater financial requirements (i.e., co- pays, deductibles, annual or life-time dollar limits) or treatment limitations (i.e., number of visits) than the predominant requirements the plan applies to substantially all medical / surgical benefits. Note, however, that the law does not require employers to cover mental health or substance use treatments if they are not already offered.


7 SAMHSA LEADERSHIP DIRECTION More collaboration between SA and MH (Behavioral Health)--- Also, among federal agencies ◦ Combined Block Grant Application: Braided Funding ◦ Co-occuring Disorders Integration of BH and primary care ◦ FQHC’s/medical homes Recovery Focus/Recovery Support Services Trauma Informed screening and treatment Military Families & Unique Cultures: Ethnic minorities; LGBTQ populations; Tribes; Women and girls Outcome Measures and Data Collection- standardization Prevention (Suicide, Tobacco, Underage drinking, prescription drugs) ◦ Focus on Communities--Prevention Prepared Communities / Strategic Prevention Framework

8 ONDCP National Drug Control Strategy Develop Prevention-Prepared Communities Spread Prevention to the Workplace Enable Law Enforcement Officers To Participate in Community Prevention Programs in Schools, Community Coalitions, Civic Organizations, and Faith-Based Organizations Preventing Drugged Driving Expand and Evaluate Screening for Substance Use in All Health Care Settings Identify & Make Available Additional Training in Evidence-based Practices for Substance Use Disorder Assessment and Care to Healthcare Professionals Providing Care to Military Health System Beneficiaries

9 ONDCP National Drug Control Strategy Expand Addiction Specialty Services in Community Health Centers Increase Addiction Treatment Services Within the Indian Health Service Foster the Expansion of Community-Based Recovery Support Programs, Including Recovery Schools, Peer-Led Programs, Mutual Help Groups, and Recovery Support Centers Tackle Co-Occurring Disorders Using a Community-Based Response

10 Public Funding Environments  Budget constraints Unprecedented economic challenges Of the first trillion dollars of budget cuts, a third will come out of defense spending. The other two-thirds will come out of education, job training, infrastructure, low-income housing, energy assistance, research and development of alternative energy sources and other "discretionary" programs. The remainder of the budget cuts will be decided by the end of the year. A congressional commission will present Congress with recommendations for $1.5 trillion more in cuts DEFICIT REDUCTION :

11 TEXAS Public Funding Environments $3.8M Biennial SUD budget reduction $3.8M block grant reduction for not meeting MOE 5% Medicaid Rate Reduction (Avoided) Criminal Justice Initiative Funding stayed fairly in-tact. SUD Medicaid Benefit under legislative Review for Cost Effectiveness

12 PHYSICAL MEDICINE Creation of American Board of Addiction Medicine: ABAM is the nation’s first medical specialty board Medicare codes for SBIRT Reimbursement for screening and brief intervention is available through commercial insurance CPT codes, Medicare G codes, and Medicaid HCPCS codes. The American Society of Addiction Medicine (ASAM) has released a new definition of addiction highlighting that addiction is a chronic brain disorder and not simply a behavioral problem involving too much alcohol, drugs, gambling or sex. This the first time ASAM has taken an official position that addiction is not solely related to problematic substance use.


14 MOVING FORWARD: What to Expect: Behavioral Health- less separation between MH & Substance Abuse Integration with Primary Care-  ACOs and Patient-Centered Medical Home(health home) models/FQHC’s Coding and electronic billing (EDI) Managed care and utilization review Private Insurance, Medicaid as primary payers Competition Marketing

15 MOVING FORWARD: What to Expect Joint-venture /partnerships /Mergers & Acquisitions Emphasis on mission-critical IT (infrastructure, certified systems, Meaningful Use) Shared services (technology networks) Quality management and reporting Medication assisted treatment (MAT) Care/Case Mgmt Standardization More Outpatient--Room & Board separate from “residential”

16 MOVING FORWARD: What to Expect Population Health Mgmt (Wellness)- “lifestyle” disease prevention Coalitions /Community “grants” Veterans and Military/Special Populations focus Recovery Support Services Public/state funding for criminal justice Higher credentials / peer specialists Workforce Shortages

17 MOVING FORWARD What Does it Look like for……

18 Focused on a Public funding. Predominately (DSHS). Attention to DSHS Mental Health and Substance Abuse Division policies & contracts Little attention to Private sector funding Limited Alliances- mostly sharing information / legislative issue support Solely SUD Attention to TDCJ, TDI, HHSC (Medicaid) and TEA or DFPS. Varied contract stipulations & Varied Regulation More interaction with Insurance (private & Medicaid), Corporate, Foundations, Private Pay, other state funding Stronger partnerships with Texas Council, TAAP, ASAM, others Behavioral health w/ SUD expertise FUTURE NOW

19 Solely ATOD prevention CHMBS Discharge Planning/Aftercare Provider waiting lists Competing for Grants Awareness of Services/Outreach Experienced Leadership “Wellness”, Mental health promotion & Lifestyle illness prevention with ATOD specialty. Family Services. Integrated technology/software systems Recovery Support Services Client Choice Competing for Patients Marketing Services CEO retirements/Succession planning/Leadership Development NOW FUTURE

20 Education focus- Clinical, Programming, Contract Management, Leadership Meetings & conferences Little Primary Care interface Licensure Little Quality Management Assist Primary group representing Substance Use Disorders along with TAAP Business Education & Leadership Webinars, E-learning & conferences Arrangements as specialty care providers in FQHC’s, ACA’s, Hospital Emergency Rooms Accreditation & ASAM standards, Quality Management Assistance Mental Health American& Texas Council including substance abuse in their Behavioral Health missions, Emergence of Grassroots Recovery Organizzation “Texas Recovers” NOWFUTURE

21 Now Communication: Email, Ezine, as needed teleconference briefings, limited website Predominately Publicly funded members Member focused advocacy State-level advocacy Dues funded Independent organization Future Websites- Social Media— library- podcast reports For-Profit organizations, criminal justice providers, recovery support Grassroots Involvement Build Federal Lobby capacity Diversification: Revenue Sharing, Product Sales, Private Grants Merger

22 Strategic Directions Re-phrase language and message to indicate we are a specialty of Physical Health, Behavioral Health, and Wellness Develop active stakeholder relationships (like DSHS) with other state agencies: HHSC (Medicaid), TDI, Criminal Justice. Develop functional Partnerships with Allied Organizations Update Communication Strategies Strengthen Federal Advocacy

23 The Language of Transformation Traditional Transformational Drug and Alcohol Abuse Mental Health & Mental Retardation Substance Abuse Chemical Dependency Counselor Client Outlyer Mental Health & Substance Abuse Behavioral Health Addictive Disorders Substance Use Disorders Substance related conditions Clinician Patient Medical Specialty

24 The Language of Transformation TraditionalTransformational Detoxification Residential / Outpatient Day Treatment Rehab” Treatment Prevention Inpatient Acute Medically managed care Inpatient nonhospital rehabilitation facility Sub-Acute rehabilitation Partial Hospitalization Medically monitored care Self Maintenance Health Promotion Prevention in terms of Wellness Prevention in terms of Lifestyle Diseases

25 A Behavioral Health Leadership Organization

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