Healthcare Reform and Beyond Advancing the Conversation

Advancing the Conversation
The Impact of National Trends on NC
May 27, 2010
Healthcare Reform
and Beyond
Reform Preview
Overview of what the new
healthcare system will look like
Review of key addiction
Timeline for implementation
Next steps
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
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
What does it do?
Creates health exchanges for individuals and
small employers to pool risk and purchase
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
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
Allows adult children to remain on their
parent’s insurance until their 27th birthday
Creates a national high-risk pool for adults
with preexisting conditions to buy into until
Key SUD/MH provisions
SUD/MH services included in the basic
benefits package required in the
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
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
Implementation Timeline
Some provisions take effect
immediately or in the next several
Biggest changes take effect on
January 1, 2014, with full
implementation by 2019.
Key provisions for 2010
Young adults can remain on their parent’s health
plan until they turn 27
Preexisting condition exclusions prohibited for
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
Key provisions coming in 2014
All other insurance market reforms,
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
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
Next steps
2014 will be here before we know it.
Implementation will be fast and furious.
Federal agencies are already beginning to draft
Most important regulations related to SUD/MH
Benefit design
Continued guidance on parity
Changes within Medicaid
Healthcare delivery system—medical home and other
models of care
• Workforce
• Chronic disease prevention
Gabrielle de la Gueronniere
[email protected]
Dan Belnap
[email protected]
Legal Action Center
Beyond Healthcare Reform
Moving the Addiction Field Forward
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
Change of any kind is
our providers fall into
three categories.
Early Adopters
Enough said
And… the Deer in the Headlights
So, what can we do?
and use
them as
they get
run over
Provide the
and do the
best we can
Strategy for Transformation
The intervention should include:
Where we are headed
Why it’s a good thing
How the change will happen
Opportunities and Threats
Strategies for surviving and thriving
Business Tools
Advocacy, Advocacy, Advocacy
Strategy for Transformation
Moving the message
Provider trainings by state or region
NIATx tools and ACTION Campaign
SAAS dissemination with associations
Addiction field media
SAMHSA and other government
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
Strategy for Transformation
Targets of advocacy
Primary Care Insurance industry
Insurance Commissioners
…to name a few
Strategy for Transformation
Role of the Block
Transition funding
Cover the uninsured
Services for “habilitation”
Wrap-around services
Recovery support services
The Key : Provider Associations
Service providers cannot,
nor should they,
drive this road alone.
They have information and
experiences that often
go untapped.
The Key : Provider Associations
Associations play a
crucial role in providing
avenues for exchange
sharing the challenges,
successes and opportunities.
The Key : Provider Associations
True transformation
will not happen
without it.
There is an undeniable need…
But if the demand
creates a void,
someone else will
step in and fill it.
There has
never been
a more
urgent and
call for
Take a step as an agency…
Decide if your business is
worth investing in, if so:
1. Join and participate in your
2. Join the Niatx ACTION Campaign
3. Attend the SAAS/NIATx conference
4. Budget for Planning
5. Budget for Training
6. Budget for Assistance
Take a step as an association…
Decide if the NC system is
worth investing in, If so:
1. 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 Nat’l level
5. Network and learn from other
There’s work to be done…
Becky Vaughn
State Associations of Addiction Services
236 Massachusetts Ave. Ste 505
Washington, DC 20002
[email protected]