Department of Health and Mental Hygiene Behavioral Health Services 2013 and Beyond Lisa Hadley, M.D., J.D. ClinicalDirector Mental Hygiene Administration and Alcohol and Drug Abuse Administration September 25, 2013

Affordable Care Act in Maryland Better Care, Better Health, Lower Cost

ACA –Patient Bill of Rights Young adults stay on their parents’ health plans to age 26* No lifetime* or annual limits on essential health benefits for children* and adults (1/1/2014) No pre-existing condition exclusions (for children*; for adults beginning 1/1/2014) Expanded Medicaid coverage for former foster youth up to age 26 Insurance Companies can’t arbitrarily cancel your insurance just because you are sick* Preventive care without co-pays or deductibles* No pre-authorization for ER* Seniors get help with their prescription drugs* © 2013 Maryland Women’s Coalition For Health Care Reform

ACA – Medicaid Changes in Maryland Medicaid expansion to cover all adults under age 65 up to 138% of the Federal Poverty Level (FPL) – January 1, 2014 ($15,282 for individual; $31,322 for family of four) Individuals with PAC receive full Medicaid benefits – January 1, 2014 Medicaid increased enrollment projections 2014: 108, : 135, : 187,000 Medicaid benefit package remains the same Information provided by Maryland Women’s Coalition for Health Care Reform

Maryland Health Benefit Exchange: Maryland Health Connection Individuals and Families –October 1, 2013 – open enrollment in Qualified Health Plans (QHPs) starts –January 1, 2014 – coverage starts Small Business Health Options Program (SHOP) –Opens January 1, 2014 –For small businesses with up to 50 full-time equivalent employees SMALL BUSINESS HEALTH OPTIONS PROGRAM (SHOP)

Qualified Health Plans (QHPs) QHPs (at 4 “metal levels”) sold at a competitive marketplace Financial assistance in the form of Advanced Premium Tax Credits for low- income individuals - 139% to 400% FPL $45,960 (indiv.) - $94,200 (family of 4) Additional cost-sharing subsidies for those with incomes under 250%, who are enrolled in a silver metal level plan Calculate Your Own: © 2013 Maryland Women’s Coalition For Health Care Reform

Maryland Health Benefit Exchange: Maryland Health Connection Eligibility Determination Plan Selection using standardized format to compare: – Premium and co-pays – Plan performance on quality measures – Plan ratings by quality and price Get help! – Website – Telephone – Navigators © 2013 Maryland Women’s Coalition For Health Care Reform

Benefit Plans Medicaid Benefits: Remain the Same Qualified Health Plans: Essential Health Benefits – Ambulatory patient services – Emergency services – Hospitalization – Maternity & newborn care – Prescription drugs – Laboratory services – Mental health & substance use disorder services – Rehabilitative & habilitative services & devices – Preventive/wellness services & chronic disease management – Pediatric, including oral & vision care © 2013 Maryland Women’s Coalition For Health Care Reform

Behavioral Health Integration in Maryland Better Care, Better Health, Lower Cost

Overview of Current System Three contracting and oversight entities within DHMH: Medicaid Alcohol and Drug Abuse Administration Mental Hygiene Administration Separate and independent –funding streams –management structures –payment mechanisms

DHMH-Behavioral Health Services Beyond 2013 Mission:  To develop and manage an outcome guided behavioral health service delivery system:  Integrating prevention, health disparities, recovery principles evidence based practices and cost effectiveness

Key features of Integrated BH System Increase public health and outcomes focus Increase prevention efforts and early intervention Promote clinical integration Increase data collection and outcome measurement One point of contact for BH providers Coordination for individuals moving between Medicaid and Maryland Health Benefit Exchange Preservation of Safety Net Reduce Health Disparities

Significant Changes Planned ADAA and MHA to reorganize into a single Behavioral Health Administration – July 1, 2014 One Administrative Services Organization (ASO) will manage behavioral health benefits for Medicaid Recipients and uninsured New integrated regulations Accreditation

Behavioral Health Administration –Restructured organizational chart –Staff integration and cross-training –Increased public health mission Overdose Prevention Initiative, Suicide Commission, Drug Monitoring, Smoking Reduction, Primary care consultation, Problem Gambling, Early Intervention

BHA Organizational Chart

Administrative Services Organization Manage behavioral health benefits for Medicaid Recipients and uninsured Single point of contact for BH providers Collect and analyze data Make data available to local authorities to improve monitoring and management of BH services Train and assist providers new to ASO system

Regulations and Accreditation  Streamline regulations and maintain quality of care  Accreditation –Consistent with current medical practice –Reduces redundancy –Simplification of the regulations with some degree of flexibility –Integrates evidence based practice  Regulations to address services not covered by accreditation

Need for coordination of care Promote clinical integration of MH, SUD and Somatic care Health Homes –PRP –Mobile Treatment –OTP

Next Steps Budget amendment for merger of MHA and ADAA to be presented to The General Assembly 2014 Assess capacity of BH system and prepare for Medicaid expansion and QHPs Continued stakeholder involvement

Next BH Stakeholder Meetings September 30, :30pm-4:00pm at UMBC Tech Center October 25, :00pm-4:00pm at UMBC Tech Center November 20, :00am-12:00pm at UMBC Tech Center

Additional Information Available ACA BH Integration in Maryland Maryland Health Benefit Exchange Maryland Suicide Prevention Conference