BUDGET/LEGISLATIVE REPORT March 2015

SAMHSA 2016 BUDGET HIGHLIGHTS (proposed in the President’s budget) SAPT Block Grant is level-funded ($1.8 billion). SBIRT is proposed for a cut, from $44.9 million to $30 million. CSAP is proposed to receive $210.9 million, an increase of $35.8 million.  $12 million is identified to provide grants to states to purchase naloxone, equip first responders in high-risk communities with naloxone, and support education on fatal overdose prevention. CSAT would have a decrease of $40.8 million, down to $320.7 million.

The National Institute on Drug Abuse would receive $1.05 billion, an increase of $18.8 million. The Access to Recovery program would be eliminated, removing $38.2 million from SUD treatment funding.

FY Block Grant Application Continues to allow states to submit an application for both MH & SUD services. Reflects the ACA’s emphasis on coordinated and integrated care. Block Grant funds should be directed toward 4 purposes:  To fund priority treatment and support services for individuals without health insurance or for whom coverage is terminated for short periods of time.  To fund priority treatment and support services not covered by Medicaid, Medicare, or private insurance for low-income individuals, and that demonstrate success in improving outcomes and/or supporting recovery.

 For SAPT funds, to fund primary prevention: universal, selective, and indicated prevention activities and services for persons not identified as needing treatment.  To collect performance and outcome data to determine the ongoing effectiveness of behavioral health promotion, treatment, and recovery support services. There is some indication that SAMHSA will approve the use of a certain percentage of SAPTBG funds to pay for transitional housing for individuals in recovery. In addition to the targeted/required populations and/or services required in statute, states are encouraged to consider the following populations:

 Individuals with mental and/or substance use disorders who are homeless or involved with criminal justice systems.  Individuals with mental and/or substance use disorders who live in rural areas.  Underserved racial and ethnic minority and LGBT populations.  Persons with disabilities.  Community populations for environmental prevention activities.  Community settings for universal, selective and indicated prevention interventions, including hard-to-reach communities.

NACBHD LEGISLATIVE PRIORITIES Institutions for Mental Disease (IMD) Exclusion Revision (awaiting introduction) would revise, but not eliminate, the current Medicaid IMD exclusion. Specific provisions include:  Up to 90 days of non-hospital residential care per year would be eligible for Medicaid reimbursement.  Up to 15 days of hospital-based care per year would be eligible for Medicaid reimbursement for persons served through evidence-based programs in hospital placements.  The proposed legislation, which applies to both MH and SUD services, recognizes the healthcare reforms implemented by the ACA, new financing models, and modern managed care practices.

Behavioral Health Information Technology Act (awaiting introduction) would correct an oversight in the 2009 HITECH Act that excluded providers of behavioral health services from funding, by extending Medicaid and Medicare reimbursement for meaningful use of electronic health records by BH professionals providing clinical care at psychiatric hospitals, and MH & SUD treatment facilities. Veterans Access to Community Care Act of 2015 (S 207) would require the Secretary of Veterans Affairs to use existing authorities to provide integrated health care to veterans using community-based services, such as MH and/or SUD treatment, if that specific service is not provided by a VA facility within 40 miles.

PARITY Budget Issue: Department of Managed Health Care is requesting 11 positions to address the workload associated with conducting surveys of the 45 health plans in California affected by the federal Mental Health Parity and Addiction Equity Act.  DMHC will review health plans’ Evidences of Coverage for compliance with the parity law, generally focusing on whether benefits for behavioral health are subject to the same cost-sharing and utilization-management requirements as medical conditions.  According to DMHC, it is still early in the Department’s review of parity compliance filings, so it is not yet possible to make industry-wide assessments of compliance.

Parity (cont.) Despite federal parity laws, private insurers still implement benefits management, pre-approval and re-approval approaches that interfere with patients gaining timely access to treatment (i.e. “fail first” requirements). In cases where a patient is on long-term medication assisted treatment, a provider may be required to “re-authorize” continued treatment every 6 months, a burden that is not required for medication management of other chronic diseases.

New Legislation  AB 623 (Wood) – Prescription Drug Abuse Expresses legislative intent to enact legislation to address the problem of prescription opioid pain reliever abuse. According to the author and proponents, this bill would make it easier for healthcare providers to prescribe opioid pain medication for a less than 30-day supply to limit the number of pills circulating for theft or misuse, and provide more patient counseling from pharmacists on how to properly store and dispose of unused medications. CBHDA Position: Watch Pending Further Clarification

New Legislation (cont.)  AB 838 (Brough) - Sober Living Homes Requires a recovery house that is owned or operated by a licensed community care facility, and that functions as an integral component of that facility, to be deemed a facility that provides residential treatment services under the license of the community care facility, and to be subjected to the inspection and enforcement provisions of residential licensing. There is concern that this bill could weaken protections that recovery homes have under fair housing and ADA law, and make these homes more vulnerable to certain types of NIMBY actions. CBHDA Position: Oppose Unless Amended

 AB 848 (Stone) – Medical Services/SUD DetoxTreatment Allows for physicians and other appropriate medical personnel to be available on-site in residential substance use disorder treatment facilities that provide detoxification services. CBHDA Position: Support  SB 11 & SB 29 (Beall) - Mental Health Training for Peace Officers These are companion bills that increase the number of hours of evidence-based behavioral health training required in Field Training and continuing education programs for peace officer trainers and trainees. CBHDA Position: Support

 SB 482 (Lara) – Prescription Drug Monitoring Requires that pharmacies and clinics use the CURES system for the electric monitoring of the prescription and dispensing of controlled substances. CBHDA Position: Watch Pending Further Clarification  SB 515 (Beall) – Proposition 47 Funds States legislative intent to enact legislation that establishes funding priorities for the moneys distributed from the Safe Neighborhoods and Schools Fund pursuant to Prop. 47, in particular the 65% of the total funds designated for mental health and substance use disorder treatment and diversion programs. CBHDA Position: Watch Pending Further Clarification

 SB 614 (Leno) – Establishes a Peer and Family Support Specialist Certification Program administered by DHCS. This program will offer training and certification for peers to deliver services in behavioral health settings, and would enable California to receive federal funds for this purpose. Behavioral health includes mental health and drug and alcohol use disorders. CBHDA Position: Sponsor

1. Ensure Safety Net Funding 2. Affordable Care Act/Parity 3. Care Integration/Value Purchasing/Delivery System Reform 4. Opioid/Heroin Problem 5. Workforce Development 6. Community Culture and Strengths Initiative * Submitted by NACBHD Mental Health & Substance Use Disorder Stakeholder Group