September 2010

Dear Readers:

I am not sure how Martha Wash and the Weather Girls would feel about the adaptation of their signature song, but here in Washington it sure feels like "it's raining regs."  Every time you turn around some agency of the Department of Health and Human Services is releasing a regulation, or seeking comment on some proposal or another. This edition of Addiction News Now provides information on many of the current opportunities. To the extent possible, the National Council will make draft comments available and we invite your participation in this process.

Two recent documents really caught our attention. The first is SAMHSA's description of a "Modern Addictions & Mental Health System" and the second is a letter that Secretary Sebelius sent to all of the Governors in July to mark the 20th Anniversary of the Americans with Disabilities Act (ADA).  Both of these documents suggest that in light of the passage of the Patient Protection and Affordable Care Act (ACA), serious attention needs to be given to how the SAMHSA's block grants are used in the states. 

That is to say, that in a world characterized by universal coverage the vital federal resources contained in the block grants need to be carefully targeted so that they can provide services not available through Medicaid, or by the private insurance purchased through the state-exchanges.  One has to believe that Governors and State legislatures will be thinking about this question, especially in light of the ongoing revenue shortfalls that are projected for the coming years.

They also suggest some of the hard work ahead for states and providers in terms of understanding who will become eligible for coverage in 2014, what kind of services will be available to them, and how those services will be accessed.  We can start working on some of these issues now, especially the "who", by mapping the clients currently in services with an eye toward their current funding source and income level to project sources of coverage come 2014.

For the "what" and "how" we will need to be vigilant regarding the release of regulations governing services in the exchange and the Medicaid expansion, as well as guidance regarding the creation of the exchanges.  The challenge before us is to ensure that the potential opportunity contained in healthcare reform materializes for persons with addiction disorders.   

Sincerely,

Chuck Ingoglia, MSW
Vice President, Public Policy

 

Resources and Reminders
 

National Council Provides Comments to SAMHSA on Description of a Modern Addictions & Mental Health System
Earlier this summer, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a draft position paper, describing a modern addictions and mental health system. This document is designed to foster discussion among the Department of Health and Human Services and other federal agencies on how best to integrate mental and substance use disorders into the health reform implementation agenda and also provide guidance to state agencies that are presently making decisions about services available to these populations.
 
The draft position paper states, “The vision for a good and modern mental health and addiction system is grounded in a public health model that addresses the determinants of health, system and service coordination, health promotion, prevention, screening and early intervention, treatment, and recovery support to promote social integration and optimal health and productivity.  The goal of a “good” and “modern” system of care is to provide a full range of high quality services to meet the range of age, gender, cultural and other circumstances presented with a reasonable waiting period for access to services.”
 
The National Council commends SAMHSA for the initiative and foresight it has exhibited in the creation of its position paper and provided several recommendations that would help to highlight the evidence/effectiveness of individual interventions on individuals with mental illness and/or addictions.
 
In addition, the National Council states that the proposal to establish {federally qualified behavioral health centers (FQBHCs)}would support SAMHSA’s vision of a modern addictions and mental health system in several key ways by establishing uniform service requirements that mirror almost exactly the continuum that SAMHSA has proposed.
 
You can read the National Council’s comments, in their entirety, online. Stay tuned to the Public Policy Update for a more updated version of SAMHSA’s position paper on a modern addictions and mental health system in the near future.

Secretary Sebelius encourages Governors to Develop New Strategies regarding SAMHSA's Block Grants
On July 28, Secretary Sebelius wrote a letter to the nation's Governors celebrating the 20th anniversary of the passage of the American's with Disabilities Act (ADA). The expansion of Medicaid under the Affordable Care Act would become effective in 2014 and has implications for the Block Grants.  Secretary Sebelius wrote that "This expanded coverage creates an opportunity for states to use the Substance Abuse and Mental Health Administration's (SAMHSA) Block Grants in targeted ways to expand and support those services available under Medicaid and create models of care that effectively integrate medical and behavioral services." She indicated that the Department of Health and Human Services (HHS) and states will "collaborate to identify the best ways to support persons in recovery from substance abuse and/or mental illnesses with investments in non-Medicaid covered support services." She concluded this discussion by encouraging the Governors to make the most of this opportunity to "improve patient care and community outcomes" and to start planning now.

Providing Mental Health and Addiction Services to Veterans
The National Council has developed a guide to provide clarifying information about Veterans Administration Services and the Tricare insurance program sponsored by the Department of Defense. Providing Mental Health and Addiction Services to Active Duty Soldiers and Veterans includes brief descriptions of the programs as well as links to additional detailed information.  

Register for Upcoming National Council Webinars; Access Recordings Online
The National Council invites you to join us for the following webinars:

Understanding Primary and Behavioral Healthcare Integration is an essential primer for staff, consumers, and others who need to hear how primary and behavioral healthcare integration is becoming a vital part of the behavioral health system of care. This webinar will take place at 2:00pm eastern on Wednesday, September 15th.

Healthcare Reform: Implications for Employers. This 90 minute webinar will review the key provisions of the legislation that will impact employers as they consider the best strategy for offering healthcare coverage to their employees. Expert consultants from Avalare Health, a leading advisory company focused on healthcare business strategy and public policy will speak on this webinar, which will commence at 2:00pm eastern on September 23rd. 

Healthcare Reform-Implications for Behavioral Health Providers.  This webinar is offered by CoOccuring Disorders Innovation and Integration, a SAMHSA-supported initiative. The Patient Protection and Affordable Care Act ensures that the role of behavioral health in the healthcare system will change. This webinar will provide information as to how healthcare reform will affect the role of States, behavioral health providers, and consumers in regard to clinical and fiscal changes, including Medicaid. Chuck Ingoglia, Vice President of Public Policy at the National Council, Dale Jarvis, Managing Consultant at MCPP Consulting, and John O’Brien, Senior Advisor to the Administrator on Health Finance, SAMHSA will be speaking on this webinar, which is scheduled for September 21, 2010 from 2:00-3:30pm eastern.

Visit the National Council’s website to register for these and other upcoming webinars.

Additionally, please refer to the National Council website for recordings on previous Webinars that provide useful information on healthcare reform, client outcomes and Medicaid as well as other issues.

SAMHSA issues guides on alcohol pharmacotherapy
The Substance Abuse and Mental Health Services Administration (SAMHSA) has issued new Quick Guides on alcohol pharmacotherapy. These quick reference tools provide guidance for the use of acamprosate, disulfiram, oral naltrexone and injectable naltrexone in the treatment of alcohol use disorders. There are two versions available: one for counselors and one for physicians.

Toolkit for Evidence-based Practices on Integration Available from SAMHSA
As part of its series on Knowledge Information Transformation (KIT), SAMHSA has released an Evidence-based Practice KIT on Integrated Treatment for Co-occurring Disorders. The KIT covers issues related to dual diagnosis treatment for individuals with co-occurring mental illness and substance use disorders. Resources include “Getting Started with Evidence-based Practices,” “Building Your Program,” “Training Frontline Staff,” and more.
 
National Council Launches Healthcare Reform Blog
The National Council is pleased to announce the launch of our new healthcare reform blog, MentalHealthcareReform.org. The blog will serve as a clearinghouse for all of our resources, news, and technical assistance on healthcare reform implementation. MentalHealthcareReform.org includes all of the resources you’ve typically found on our website, Public Policy Update, Technical Assistance Update, and mailing lists – consolidated into one place for easy navigation and access. In addition, we’ve posted links to valuable resources from other organizations. Check out  MentalHealthcareReform.org to view the latest news and information on Medicaid, Medicare, integration, parity, payment reform, and much more!

Patient Centered Medical Homes: Caring for the Whole Person
The latest issue of National Council Magazine is dedicated to healthcare reform and features an article discussing team-based care management as a key component of the Patient Centered Medical Home.  The article describes how behavioral health providers have an opportunity to demonstrate the quality and cost benefit of adding mental health and substance used services to the primary care setting and of adding primary care to specialty behavioral health settings.

Study Offers Evidence on Screening for Drug Use in Primary Care
A new research study asserts that a single-question screen for drug use is valid and could lead to more widespread implementation in primary care practices. The study, by Peter C. Smith et al, is entitled “A Single-Question Screening Test for Drug Use in Primary Care.” 
 
SAMHSA Publication Finds Benefits of Substance Use Treatment Outweigh Costs
Investing in community-based substance use treatment is an effective way to reduce health care costs, according to a SAMHSA review of studies in three states. Data from New York, California, and Washington show a benefit-to-cost ratio of 7 to 1, largely due to decreased costs from crime and increased earnings for employers. The studies indicated that treatment reduced emergency room visits and hospital stays, reduced absenteeism and tardiness on the job, and lowered total medical costs.
 
SAMHSA & ONC Release FAQs on Applying Substance Abuse Confidentiality Regulations to the Health Information Exchange
The Office of the National Coordinator for Health Information Technology (ONC) and SAMHSA have released a document with answers to frequently asked questions about substance abuse treatment and confidentiality in an environment of increasing reliance on the electronic exchange of health data and information. The FAQs outline the general provisions of the federal privacy statute, provide guidance on its application to electronic health records, and identify methods for including substance abuse patient record information into health information exchange that is consistent with federal law. SAMHSA hosted a FAQ meeting on August 4th to provide those who were interested with the opportunity to offer input on the FAQs. Information from that meeting is available on SAMHSA’s website.

On the Hill

Due to the Congressional August Recess the next ‘On the Hill’ segment will be published in the October edition. 

In The News

Obama Administration Issues Regulations on Streamlined Insurance Appeal Process Under Healthcare Reform; National Council Submits Comments
The Department of Health and Human Services in July issued an interim final rule (IFR) providing for a streamlined process by which individuals can appeal insurance company decisions about their coverage, including both an internal claims and appeals and an external review process. While most states and insurance plans already have such processes in place, there is great variation in these plans. These regulations attempt to establish a baseline of consumer protections for healthcare beneficiaries in the private sector. HHS has issued a fact sheet explaining the IFR in greater detail.

The National Council has submitted comments to HHS in response to the IFR. Our comments urge HHS to increase transparency, strengthen consumer protections, and provide assistance to providers, who are often the key intermediaries between patients and insurance plans.

HHS Releases Guidance on Implementing Healthcare Reform Law’s Prohibition on Annual Limits
Under the Patient Protection and Affordable Care Act, annual limits on the value of insurance benefits will be prohibited beginning in 2014. The law calls for restrictions on annual limits beginning this month. The Department of Health and Human Services (HHS) has released guidance on these restrictions, including a process by which insurance plans may receive a 1-year waiver from compliance with the requirements.

In July, HHS published an interim final rule outlining the allowable annual limits on the dollar value of health benefits. These limits cannot be lower than: $750,000 for plan years beginning Sept. 23, 2010 to Sept. 22, 2011; $1.25 million for plan years beginning Sept. 23, 2011 to Sept. 22, 2012; $2 million for plan years beginning Sept. 23, 2012 to Dec. 31, 2013; and are prohibited thereafter. In a recent informational bulletin, HHS detailed the process by which plans may gain a 1-year exemption from these requirements. The guidance states that plans must prove that compliance “would result in a significant decrease in access to benefits or a significant increase in premiums.” The waiver option is available for only one year, and plans would have to reapply annually in accordance with future guidance from HHS.

September is National Alcohol and Drug Addiction Recovery Month!
SAMHSA and the Center for Substance Abuse Treatment (CSAT) in partnership with the National Inhalant Prevention Coalition (NIPC) have developed a National Alcohol and Drug Addiction Recovery Month (Recovery Month) local coordinator’s toolkit. The theme is Join the Voices of Recovery: Now more than ever and emphasizes the need to use community resources to educate people about this disease and help those with substance use disorders. The Recovery Month toolkit provides a guide for local activities and SAMSHA sponsored Community Forums/Events held throughout the country. To get the latest information about national and local activities, go to the Recovery Month website at www.recoverymonth.gov.

ONDCP awards $85.6 million to prevent youth drug abuse
The Office of National Drug Control Policy (ONDCP) announced $22 million in new Drug Free Communities Support Program grants to 169 communities and 16 new Mentoring grants across the country. These grants are in addition to the $63 million in Continuation grants simultaneously released to 549 currently funded DFC coalitions and 7 DFC Mentoring Continuation coalitions. A listing of grantees can be found at the Office of National Drug Control Policy website.
 
Congress Passes Fair Sentencing Act
On July 28, 2010, Congress passed the Fair Sentencing Act which will reduce sentencing disparity between crack cocaine and powder cocaine violations. The Act, which became effective August 3, 2010, reduces the 100 to 1 sentencing disparities between crack and powder cocaine to 18 to 1. This is the first time in three decades years that Congress has reduced a mandatory minimum sentence.