Public Policy Update: September 22, 2011
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September 22, 2011
President Obama this week released a deficit reduction proposal that would cut federal spending by a sweeping $3 trillion, well in excess of the $1.2-1.5 trillion mandated under the Budget Control Act. This total includes about $320 billion in cuts to Medicaid and Medicare, plus additional cuts to other health programs.
The President's proposal calls for nearly $66 billion in Medicaid cuts over ten years. Of greatest importance to behavioral health providers, his plan would implement a single, “blended” matching rate for Medicaid and CHIP starting in 2017. The enactment of a blended federal would result in an overall federal spending reduction of $14.9 billion by consolidating the multitude of federal matching rates for various Medicaid and CHIP populations within each state to a single, uniform rate for each state (rates would still vary between states). The net impact would be a reduction of federal Medicaid money for states, leaving them to substitute state funds or find ways to reduce Medicaid budgets.
The proposal also calls for increased state flexibility in the management of Medicaid benefits, including flexibility to require "benchmark" benefit plan coverage for non-elderly, non-disabled adults with incomes over 133% of poverty.
In regards to Medicare, the proposal would make cuts of about $248 billion. These include cuts to certain rural health providers starting in 2013, adjusting Medicare drug rebate policies to mirror Medicaid's policies starting in 2013, and initiating Medicare premium increases for the wealthiest seniors beginning in 2017.
The President’s proposal also included a $3.5 billion cut to the Affordable Care Act’s Prevention and Public Health Fund over 10 years starting in 2014. This fund currently supports primary care and behavioral health integration activities, along with Screening, Brief Intervention, and Referral to Treatment (SBIRT) and other important prevention activities.
With slightly less than two months remaining in the Joint Select Committee on Deficit Reduction’s negotiations to find at least $1.2 trillion in spending cuts, the President’s proposal may influence the supercommittee’s discussions and strategy. Despite his proposed Medicaid cuts, the President has publicly stated that he would veto any deficit reduction plan that cuts federal funds to Medicare and Medicaid without raising revenues. The supercommittee has not yet given any public indication of whether they will seek to cut Medicaid or Medicare in their negotiations. However, Medicaid is protected from the automatic spending cuts that will take place should the supercommittee fail to reach an agreement. Click here to find out how you can speak up to protect Medicaid today!
Senate Appropriations Committee Approves 2012 Labor-HHS Spending; Stopgap Spending Bill Fails in House
On a party-line vote of 16-14, the Senate Appropriations Committee yesterday approved the 2012 Labor-HHS-Education appropriations bill. The bill includes a $27 million cut to SAMHSA and maintains level funding from 2011 for the Mental Health Block Grant and the Substance Abuse Prevention and Treatment Block Grant. However, it also dedicates $280 million of the Prevention and Public Health Fund (an increase of $135 million over fiscal year 2011) to Community Transformation Grants for implementing evidence-based public health interventions to reduce obesity and smoking and make preventive services more accessible. Click here to read the Committee’s summary of the bill.
The most contentious issues during the committee debate were a series of amendments put forth by Republican committee members to defund the Affordable Care Act or require additional scrutiny and analysis of its provisions. Democrats defeated each amendment but were unable to win any Republican votes for final passage of the bill. The House has not yet taken action on its version of the Labor-HHS-Education bill.
In related 2012 budget news, the House this week failed to pass a stopgap spending bill that would keep the government running into the beginning of the new fiscal year while Congress finishes up its work on the 2012 spending bills. The bill failed in a pair of related disputes over disaster aid and cuts to federal spending: Democrats united against the bill for its spending cuts to a Department of Energy manufacturing loan program (used to offset a portion of enhanced federal disaster aid), while a substantial block of fiscally conservative House Republicans objected to what they saw as insufficient levels of cuts to federal spending. Congress must pass a stopgap bill before Sept. 30 to avoid a government shutdown.
As the deficit reduction committee continues its negotiations on cutting $1.2 trillion from the federal budget, programs that support behavioral health are in serious danger. The National Council this week released a detailed outline describing the potential losses to Medicaid and other behavioral health funding. Read our analysis here.
Every voice matters in the fight to prevent Medicaid and behavioral health programs from losing critical funding. If you have not already done so, please write your Members of Congress today and ask them to tell the supercommittee not to cut Medicaid or behavioral health!
Your calls and emails have already made a difference in protecting Medicaid from automatic cuts under the Budget Control Act, an accomplishment we can all be proud of. But the deficit deal could inflict unprecedented levels of cuts on Medicaid and other behavioral health programs. Right now, we have a chance to affect what that deal looks like. Please continue the fight for Medicaid by taking action today!
The Office of the National Coordinator for Health Information Technology (ONC) this month released its strategic plan for 2011-2015. The plan was informed by widespread stakeholder input during a comment period earlier this year. In response to this feedback, ONC made several changes to the plan so as to: support the inclusion of providers not eligible for incentive payments under the Medicare and Medicaid EHR Incentive Programs in information exchange for purposes of care coordination; address barriers to adoption and health information exchange; and support the harmonization of standards.
The Strategic Plan specifically addresses behavioral health providers and issues of access to financing. “Strategy I.C.3: Support health IT adoption and information exchange in long-term/post-acute, behavioral health, and emergency care settings” specifies that the Substance Abuse and Mental Health Services Administration (SAMHSA), in collaboration with ONC, will explore approaches to support the adoption of certified EHR technology within the behavioral health community.
This section also indicates that ONC is working with SAMHSA and the Health Resources and Services Administration (HRSA) to address the policies and standards concerning the unique needs of behavioral health IT adoption and information exchange. This includes work on data and meta-data standards that can provide additional clinical context, such as patient preferences and sources of data, to help enable data segmentation and secure exchange of sensitive health information. The ability to integrate mental health data into the primary care and related safety net system is essential for coordinating care.
The Strategic Plan is now available online.
It’s September 2011. If you want to ace those Healthcare Reform SATs for admission to new payment and delivery systems by 2014, you must start preparing NOW. Increased access, increased accountability, new payers, health homes…every section requires intense study and strategic planning. Get up to speed with the industry’s most advanced prep service, delivered through three important reports and discussions from the National Council.
Start with the National Council’s Increasing Access to Behavioral Healthcare: Managed Care Options and Requirements report and webinar, to be held Oct. 10 from 3:00-4:30pm eastern time. The National Council report on managed care provides answers to questions such as
- Should you carve in with managed care organizations or carve out with managed behavioral health organizations?
- What type of services are MCOs and MBHOs looking to contract for and what makes your organization appealing as a contractor?
- What type of quality and cost outcomes are managed care entities looking for?
- What do managed care contractual obligations and plan offerings look like?
Don’t forget to discover the secrets to zero wait times, zero no-shows, reduced staff time, and millions in cost savings — in the second in this series, the Access Redesign Project Summary Report The report explains how 45 community behavioral health organizations in three states, cut consumer wait times by more than half (53 percent), reduced staff time by 40 percent, and saved an average of $222,000 annually. Some of the efficiencies used by the centers included:
- Implementing walk-in policies to decrease no-shows and cancellations
- Using reminder programs to encourage patients to keep their appointments
- Streamlining the documentation process by removing redundant information and simplifying forms used to capture patient data
- Spending more time with patients to involve them in their recovery plans and less time with post-session paperwork
Stay tuned for an upcoming National Council LIVE webinar on access redesign.
Finally, the National Council’s new Mental Health and Substance Use Provider Readiness Assessment report describes 23 important competencies and strategies necessary to succeed in the new “healthcare ecosystem.” The tool is organized around five areas that address a range of internal and external issues. It points to how you can assess and redesign internal operations to better align with healthcare reform and demonstrate to consumers, healthcare providers, and state policymakers that your organization is high-performing, quality-focused, and efficient.
Start by downloading the high-level Mental Health and Substance Use Provider Readiness Assessment report. To purchase an online readiness assessment survey customized to your organization (National Council member price: $100, Guest price: $150), go to our online store.
Then join us for a National Council LIVE webinar on Provider Readiness Assessment, customized to your organization on September 30, 2 – 3:30 pm eastern, by David Lloyd, Founder, MTM Services. Register now.
