NYAPRS Note: Coordination between advocates and agencies at the Federal level has yielded top recommendations for focus from HHS and SAMHSA for the remainder of the current presidential administration. These recommendations will be reviewed by Secretary Burwell and may be implemented through initiatives that could spur funding at the state level, particularly for the policy and program work toward integration and enhancement of substance abuse services. See the recommendations below:
Field Encouraged by Federal Interest in Addressing Key Behavioral Health Issues
Mental Health Weekly; Vol 25 Num 11, 3/16/2015
With only 22 months left in the Obama administration, the field is optimistic about ramping up the behavioral health agenda following a meeting February 27 with Health and Human Services (HHS) Secretary Sylvia Burwell and a subsequent submission of key recommendations, including parity implementation and addressing workforce needs, that could go a long way toward impacting the mental health and substance use disorder arena.
During the meeting with Burwell and Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator Pam Hyde, the Behavioral Health Stakeholder Group highlighted four areas: the Affordable Care Act (ACA) and parity, care integration and value purchasing, the opioid issue, and workforce needs.
Following the meeting, the group was asked by a member of Burwell’s staff to submit 10 key recommendations for action that the secretary and the Obama administration could undertake to advance behavioral health work. The preparation of the recommendations submitted March 2 was spearheaded by Ron Manderscheid, Ph.D., executive director of the National Association of County Behavioral Health and Developmental Disability Directors; Robert Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors; Robert Glover, Ph.D., executive director of the National Association of State Mental Health Program Directors; and Paul Samuels, director and president of the Legal Action Center.
The resulting list builds upon the work of the group, including input from 27 organizations, conducted over the weekend following the meeting. “We consulted with as many groups as possible for input into this process,” Manderscheid told MHW.
The most important item on the list, and one that should be addressed immediately, Manderscheid said, is to maintain and increase funding for the Community Mental Health Services Block Grant and Substance Abuse and Prevention Treatment Block Grant in order to address the needs of people who remain uninsured and provide for critical health services and the social wraparound services not covered by the ACA.
Manderscheid noted that the willingness of federal leaders to invite dialogue about mental health and substance use disorder issues is unlike anything he’s seen during his whole career in D.C., in a Republican or Democratic administration. “This is a wonderful opportunity,” said Manderscheid. “The secretary is fully engaged in mental health and SAMHSA responded to an interview request by MHW by releasing the following statement: “The Administrator continues to have follow-up conversations with the Secretary and her team, including senior officials at HRSA [Health Resources and Services Administration] and CMS [Centers for Medicare & Medicaid Services]. There is a strong commitment at the highest levels to making significant progress on the issues raised. Opioids, Care Integration and Payment Reform, Parity, and Workforce are areas of shared interest and urgency.”
Highest-priority needs
“These 10 recommendations are deemed important by members of the group and we’re waiting to see which ones are the highest priority to the secretary,” Glover told MHW. “Safety net funding and ensuring the active enforcement of parity are essential. This is an exceptional opportunity.”
“We really appreciate the very strong commitment the secretary has for addressing the needs of people with mental health and substance use issues,” Samuels told MHW. “The secretary was very engaged and very serious about finding out what the needs and concrete steps are to be taken during the time that’s left in the administration.”
The ACA and federal parity laws will present greater opportunities to provide services to many millions at risk or who have mental health or substance use disorders, said Samuels. Many health plans are not in compliance with ACA and parity law requirements, he added.
“We have a short window to revamp the service delivery system,” said Samuels. “There’s also an epidemic of opioid use spreading over the country,” he said. There are real large increases of opioid misuse and heroin over the last couple of years, and it’s critically important that the government responds to this effectively, said Samuels. The secretary was very serious about these issues and committed to a prompt response, added Samuels.
Recommendations
Below are excerpts of the recommendations submitted to Secretary Burwell by the Mental Health and Substance Use Disorder Stake- holder Group to be addressed over the next 22 months:
Affordable Care Act/parity
- “The Center for Consumer Information and Insurance Oversight (CCIIO) should … issue guidance regarding lawful compliance with the requirements of the ACA and Mental Health Parity and Addiction Equity Act, regarding both quantitative and nonquantitative treatment limitations, including issuing final parity regulations for Medicaid as quickly as possible; and conducting a review of all essential health benefits packages.
- “Facilitate enrollment of people with untreated MH/SUD and minimize interruptions of coverage and care by … working with the Department of Justice in providing guidance to states and localities in order to facilitate enrollment and linkage to mental health, substance use disorder and physical care of everyone in the criminal justice system, including ceasing the termination of Medicaid of those who are incarcerated.…”
Care integration/value purchasing/delivery system reform
- “Provide practical models and examples of delivery system reform initiatives, including those that incorporate social wraparound services, so that state, county and city mental health and substance use disorder provider entities can undertake key steps to foster reforms that will lead to good integrated care.”
- “Facilitate operational planning and reforms so that more effective working relationships can be developed between MH/SUD providers and primary and physical health care providers, specifically FQHCs [federally qualified health centers].”
- “HHS has a critical window in the next two years to catalyze national implementation of first-episode psychosis programs. The National Institute of Mental Health (NIMH) has invested significant resources, and data will be published this summer on clinical trials for these programs.”
Opioid/heroin problem
- “Increase funding for SAMHSA to help states, counties and localities purchase naloxone. Target funding to the substance use disorder care system (state/county/local agencies, providers, families and recovery community).”
- “Maintain and increase support for treatment and prevention services addressing opioids and other drugs — including medication-assisted treatment. Provide additional funds for all effective treatments and prevention interventions.”
Workforce
- “Continue and expand Medicaid reimbursement for certified peer support specialists, including family and youth peers, addiction recovery coaches and health navigators; incentivize states to establish this access; and streamline the ability of physical health entities, including FQHCs and emergency departments, to directly bill for these services.”
- “Expand loan forgiveness, scholarship, fellowship and other workforce initiatives for MH/SUD practitioners, such as psychiatrists, psychologists, social workers, mental health nurse practitioners, marriage and family therapists, licensed counselors, certified alcohol and drug abuse counselors, addiction medicine specialists, certified prevention specialists and peer specialists, to increase the availability of licensed clinicians and improve recruitment and retention.”
- “Encourage the Health Resources and Services Administration and SAMHSA to take measures to promote systematic implementation of Suicide Prevention and the Clinical Workforce: Guidelines for Training, established by the Clinical Workforce Preparedness Task Force of the National Action Alliance for Suicide Prevention.
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