Healthcare Reform and Beyond

1
Healthcare Reformand Beyond
Advancing the Conversation The Impact of National
Trends on NC May 27, 2010
2
Reform Preview

• Overview of what the new healthcare system will
  look like
• Review of key addiction related-provisions
• Timeline for implementation
• Next steps

3
National Healthcare Reform

• After more than a year of work, missed deadlines,
  and compromises, the healthcare reform bill was
  passed and signed into law on March 23, 2010
• Some provisions take effect immediately but most
  will take effect in 2014, with full
  implementation by 2019
• Once fully implemented, CBO estimates that 95
  percent of the legal population will have health
  insurance

4
Key Things to Keep in Mind

• Preliminary discussion
• Statute provides framework, lots of remaining
  questions/ambiguity
• Scope of services/continuum of care not defined
• Years of regulations expected
• Enormous need for education and outreach

5
What does it do?

• Creates health exchanges for individuals and
  small employers to pool risk and purchase
  insurance
• Requires transparency, mandated benefits and
  other consumer protections
• Provides sliding scale subsidies for individuals
  and families up to 400 FPL to purchase or take
  up offers of health coverage
• Prohibits insurers from denying coverage to
  people with pre-existing conditions, charging
  higher premiums based on gender or health status,
  and placing annual or lifetime caps on insurance
  coverage
• Requires individuals to carry health insurance or
  pay a financial penalty

6
What else?

• Expands Medicaid eligibility to all Americans
  below 133 FPL
• Mandates newly-eligible childless adults be
  enrolled in generally less-comprehensive
  benchmark plan
• To finance the expansion, states will receive
  100 FFP for 2014-2017, 95 FFP for 2018-2019,
  and 90 FFP after 2019 for expansion population
• Allows adult children to remain on their parents
  insurance until their 27th birthday
• Creates a national high-risk pool for adults with
  preexisting conditions to buy into until
  implementation

7
Key SUD/MH provisions

• SUD/MH services included in the basic benefits
  package required in the exchange
• All plans in the exchange must adhere to the
  provisions of the Wellstone/Domenici parity act
• The parity act already applies to large group
  plans that would exist outside the exchange
• Requires that newly-eligible Medicaid enrollees,
  including childless adults, receive adequate
  health coverage that includes SUD/MH coverage

8
And.

• Includes SUD/MH in chronic disease prevention
  initiatives
• Includes SUD/MH workforce in health workforce
  development initiatives
• Makes SUD prevention, treatment, and MH service
  providers eligible for community health team
  grants aimed at supporting medical homes

9
Implementation Timeline

• Some provisions take effect immediately or in the
  next several months.
• Biggest changes take effect on January 1, 2014,
  with full implementation by 2019.

10
Key provisions for 2010

• Young adults can remain on their parents health
  plan until they turn 27
• Preexisting condition exclusions prohibited for
  children
• Group or individual market plans are prohibited
  from rescinding coverage once an enrollee is
  covered under a plan, except for cases of fraud
• Prohibition against lifetime benefit caps and
  unreasonable annual limits
• National high-risk pool for people with
  preexisting conditions created includes federal
  subsidies
• States have option to extend Medicaid coverage to
  childless adults up to 133 FPL under current FFP
• Eliminates cost-sharing for preventive care in
  Medicare and private plans

11
Key provisions coming in 2014

• All other insurance market reforms, including
• Guaranteed issue and renewability, prohibition
  of rating based on health status
• Elimination of all annual and lifetime limits
• State insurance exchanges for individuals and
  small employers with. After 2017 states can open
  exchange to large employers.
• Exchange subsidies for those up to 400 FPL
  become available
• Essential benefit requirements become effective

12
And

• States are required to extend Medicaid coverage
  to all up to 133 FPL
• Individual mandate becomes effective
• Individuals that cannot demonstrate that they
  have qualifying coverage or are exempt will have
  to pay 95 or 1 of taxable income in 2014,
  increasing to 695 or 2.5 of taxable income in
  2016
• Limited employer responsibility requirement
• Quality improvement provisions take effect

13
Next steps

• 2014 will be here before we know it.
  Implementation will be fast and furious.
• Federal agencies are already beginning to draft
  regulations
• Most important regulations related to SUD/MH
  include
• Benefit design
• Continued guidance on parity
• Changes within Medicaid
• Healthcare delivery systemmedical home and other
  models of care
• Workforce
• Chronic disease prevention

14
Questions?

• Gabrielle de la Gueronniere
• gdelagueronniere_at_lac-dc.org
• and
• Dan Belnap
• dbelnap_at_lac.org
• Legal Action Center

15
Beyond Healthcare Reform Moving the Addiction
Field Forward
16
All of this impacts how we

• Reach patients (yes, patients)
• Organize care
• Deliver services
• Finance what we do
• for the 23 MILLION people with this condition

17
SO WHATS THE PROBLEM?

• Surprise!
• Change of any kind is difficult.
• Simplistically, our providers fall into three
  categories.

18
Early Adopters
19
Enough said
20
And the Deer in the Headlights
21
So, what can we do?
Provide the information and do the best we can
Encourage EEEEthem and use them as
missionaries
Intervene before they get run over
22
Strategy for Transformation

• The intervention should include
• Where we are headed
• Why its a good thing
• How the change will happen
• Opportunities and Threats
• Strategies for surviving and thriving
• Business Tools
• Advocacy, Advocacy, Advocacy

23
Strategy for Transformation

• Moving the message
• Provider trainings by state or region
• E-strategies
• NIATx tools and ACTION Campaign
• SAAS dissemination with associations
• Addiction field media
• SAMHSA and other government agencies

24
Strategy for Transformation

• Where change will come from
• Federal policies, regs, contracts
• State policies, regs, contracts
• Provider initiatives
• Patients and their families
• Payers private and public

25
Strategy for Transformation

• Targets of advocacy
• SAMHSA
• ONDCP
• FQHC
• Primary Care Insurance industry
• MCOs
• States
• Insurance Commissioners
• to name a few

26
Strategy for Transformation

• Role of the Block Grant
• Transition funding
• Cover the uninsured
• Services for habilitation
• Wrap-around services
• Recovery support services

27
The Key Provider Associations

• Service providers cannot,
• nor should they,
• drive this road alone.
• They have information and
• experiences that often
• go untapped.

28
The Key Provider Associations

• Associations play a
• crucial role in providing avenues for exchange
• sharing the challenges, successes and
  opportunities.

29
The Key Provider Associations

• True transformation will not happen without it.

30
There is an undeniable need

• But if the demand creates a void,
• someone else will step in and fill it.

31

There has never been a more urgent and
necessary call for intervention.
32
Take a step as an agency

• Decide if your business is worth investing in,
  if so
• 1. Join and participate in your association
• 2. Join the Niatx ACTION Campaign
• 3. Attend the SAAS/NIATx conference
• 4. Budget for Planning
• 5. Budget for Training
• 6. Budget for Assistance

33
Take a step as an association

• Decide if the NC system is worth investing in,
  If so
• Develop a plan of action
• 2. Plan a 1-2 day(s) provider training
• 3. Reach out to other non traditional advocacy
  groups
• 4. Actively participate at the Natl level
• 5. Network and learn from other associations

34
Theres work to be done

• Becky Vaughn
• State Associations of Addiction Services
• 236 Massachusetts Ave. Ste 505
• Washington, DC 20002
• 202-546-4600
• bvaughn_at_saasnet.org