Healthcare Reform in 2013

Healthcare reform is becoming a reality and the importance of mental health and behavioral healthcare is receiving due notice. We find evidence of this achievement throughout the healthcare reform law - mental health and substance use services must be provided by all plans that participate in the new exchanges, and these benefits must be offered at parity. Healthcare home and Accountable Care Organization pilots must address substance use and mental health disorders. Additionally, the law includes a number of provisions specific to mental health and substance use, including authorization for new grants to co-locate services as well as new workforce development grants. Even with all the progress that has been made, many areas of policy and payment need to be improved for the behavioral health sector to fulfill its intended role in a reformed healthcare system. National and community mental health organizations around U.S. are committed to advancing the following issues: 1.) Extension of the temporary Federal Medicaid Assistance Percentage increase As part of the American Recovery and Reinvestment Act, Congress provided a temporary increase to the Federal Medicaid Assistance Percentage to help cash-strapped states meet their Medicaid obligations. An extension of this important provision is critical, given the combination of state revenue proections and Medicaid growth. 2.) Federal policy and payment equity for behavioral health organizations In recognition of the healthcare access and use challenges confronting communities that are low income or have high rates of illness and few medical providers, Congress has enacted a number of policy and payment preferences for "safety net" providers, including enhanced reimbursement under Medicaid, federal funding to provide care to uninsured people, loan guarantees, and access to federally subsidized malpractice insurance. Unfortunately, the safety net does not offer equity. To correct this situation, mental health advocates are working with other national organizations to advance the notion of federally qualified behavioral health centers. This effort includes establishing national treatment and reporting standards for organizations that choose to obtain this designation as well as a proposed reimbursement model that more accurately reflects the costs of providing services. 3.) Healthcare information technology funding fix For healthcare reform to be successful, all medical providers need to share information to better coordinate care, reduce inefficiencies, and improve client outcomes. Behavioral healthcare providers need access to federal funding for the meaningful use of health IT (information

technology). One solution is to extend Medicare and Medicaid facility payments to community mental health and addiction organizations as well as private and public psychiatric hospitals. 4.) Medicare parity implementation In June 2008, Congress enacted payment parity in Medicare's Part B benefit, which provides copayment equity for mental health and addiction services. Although this is an important step, much more needs to be done in Medicare for there to be true parity. First, the types of outpatient mental health interventions paid for by Medicare need to be extended to include, for example, case management, psychiatric rehabilitation, and other intensive community-based interventions. Medicare also must recognize mental health counselors and marriage and family therapists as independent practitioners. The policy successes of the last few years would not have been possible without the active involvement of advocates of mental healthcare - down to the individual level. Passage of healthcare reform is only the first of many steps necessary to improve the lives of people with addiction disorders and mental illness. National and community mental health organizations must continue to reply on the support and voice of the general public to bring this "unfinished business" to completion. Promised economic recovery and healthcare reform legislation are opportunities for meaningful financial commitments to mental health and addictions services and mental healthcare organizations are offering a practical actionable agenda: - The integration of primary care services in behavioral health settings: The Healthcare Collaborative Proect brings together behavioral health and primary care organizations offering a bi-directional approach for care. The need for behavioral health services in primary care is widely accepted. But the integration of primary care services in behavioral health settings remains controversial despite the fact that individuals with serious mental illness appear to have the worst mortality rates in the public health system. Therefore, mental healthcare organizations are actively pursuing single points of accountability to enhance continuity of care for this underserved population. - Cost-based-plus financing that supports service excellence: People want and deserve quality services but quality services depend on skilled staff. Low salaries have created - and are perpetuating - a recruitment, retention, and quality crisis for behavioral healthcare. We need a workforce of skilled staff delivering nationally recognized practices within organizations that live by the rule "If you don't measure it, you can't improve it. "For mental healthcare organizations, healthcare reform is an opportunity to bring "parity" to public mental health services by ending the second class status of community mental health and addiction providers in America's safety net.

- Federal mental health funding stream dedicated to mental health and integrated treatment services for the uninsured: The uninsured have exceptionally high rates of untreated mental illnesses with co-occurring addiction disorders and there is no safety net. State plans to cover the uninsured have all but disappeared and federal universal coverage plans may well be incremental. We have large numbers of individuals with treatable mental illnesses and addictions in our overburdened emergency rooms, in ails, and on the streets with no access to services that can engage them, treat them and return them to work. We must stop denying our economy productive taxpayers and wasting human lives. - Eligibility for social security disability for people with addiction disorders: Addiction has come a long way from the days when it was perceived as merely a failure of will. Today, there is growing public awareness and acceptance of addiction as a chronic, relapsing condition that requires continual monitoring and management, as do other chronic illnesses like diabetes, asthma, and hypertension and yes, mental illness. If we accept addiction as a chronic illness then we must advocate that people with addiction disorders be eligible for disability support. - Funds to support investments by behavioral healthcare organizations in information technology: We talk about information technology and service transparency, but behavioral healthcare organizations that move forward to automate their clinical systems get no support, funding, or technical assistance. We and those we serve can not continue to be marginalized. Healthcare reform and economic recovery will depend upon the expansion of information technologies and behavioral health providers must be included. - Expansion of research-based education and prevention practices: There are mental health and addiction prevention and education programs that work. These include research-based prevention initiatives that reduce the risk of childhood serious emotional disturbance by treating maternal depression, the Nurse-Family Partnership Program that has an array of consistent positive effects across multiple trials, and Mental Health First Aid - an evidence-based mental health literacy program. Now we must adequately fund and support the spread of these interventions to communities across the country.