www.TheNationalCouncil.org

National Policy Update

October 15, 2015

Chuck Ingoglia, MSW

• Fiscal year end, debt ceiling• Comprehensive mental health reform• Excellence Act implementation• National Council Hill Day

What’s ahead this fall?

2016 Appropriations

• Fiscal year ends Sept. 30, 2015• Sequestration remains in place• Different versions approved by House and

Senate Appropriations Committees– Both defund the Affordable Care Act– House version eliminates CMMI, AHRQ– Senate version makes smaller cuts across more HHS

agencies

• Complicated by debt ceiling, Planned Parenthood• Budget reconciliation…?

Comprehensive Addiction and Recovery Act (S.524/H.R.953)

Source: CDC http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

New Addictions Legislation• Treatment and Recovery Act (S.1410)

• Increases funding for the Substance Abuse Prevention and Treatment Block grant.

• Creates new programming to increase access to and strengthen substance use treatment services. 

• Supporting Positive Outcomes After Release Act (S.1409)• Requires states to suspend, rather than terminate, Medicaid enrollment

for individuals during incarceration. 

• Safe Prescribing of Controlled Substances Act (S.1392)• Establishes additional safeguards to educate providers who prescribe

opioids to treat addiction disorders.

SUD Service Delivery Options in 1115 Waivers

• Broad and deep transformation of the SUD treatment system within Medicaid• SUD as chronic disease• Aligning benefit packages, provider requirements,

reimbursement, utilization review processes, medical necessity criteria, and quality indicators with Medicare and commercial insurance

SUD Service Delivery Options in 1115 Waivers, cont.

• Comprehensive continuum of care based on industry standard: withdrawal management, short-term residential, IOP, MAT, aftercare supports such as transportation, employment, housing and peer support services.

• Primary care integration• Payment models such as shared savings and

managed care• Collecting and reporting data

SUD Service Delivery Options in 1115 Waivers, cont.

• Confirmation of ASAM level of care for the facility and independent assessment of placement for clients.

• CMS Home and Community-based Standards apply

• Must include strategy to address prescription drug abuse

• 1115 waivers must be budget neutral

6+ years in the making…

2008 2014 20152012 20132010 20112009

October 2008: Parity law enacted

January 2010: Interim Final Rule (IFR) for commercial

plans released

November 2013:

Final rule for commercial

plans released

April 2015: Notice of proposed

rulemaking (NPRM) for Medicaid managed

care released

March 2010: ACA applies parity to Exchange plans

and Medicaid expansion

June 2015: National

Council submits comments

to CMS on rule

Copayments

Mental Health Parity and Addiction Equity Act of 2008

Benefit Limits

The ACA and MHPAEA have expanded access to comprehensive mental health and addiction treatment benefits to more than 62 million Americans.

Navigating Parity

The National Council and the American Foundation for Suicide Prevention developed tools with information on parity and advice on how to select a health plan that fits your coverage needs.

Navigating Parity

Welcome to the New Insurance Marketplace

Appeals and Exceptions: Accessing Behavioral Health Services in Qualified Health Plans

Mental Health Services in New Health Insurance Marketplace

Learn your rights

Your Mental Health and Substance Use Needs in Employer-Sponsored Coverage

Appeals and Exceptions in Employer-Sponsored Insurance

Parity and Employer-Sponsored Insurance

Parity and Your Employer

Parity ResourcesThe Kennedy Forum, with the Parity Implementation Coalition, released a toolkit to help you understand your rights.

The toolkit details the requirements of the parity law and resources to file successful appeals.

Parity Tracker

Department of Health and Human Services

– Is your insurance plan improperly restricting coverage of MH/SUD services?

– Call 1-877-267-2323 ext. 6-5511

Department of Labor– Have questions about your

health plan’s compliance with the law?

– Call 1-866-444-3272

File a Complaint

Everything the light touches must be provided at parity…

…but consumers must know their right to claim it.

Questions?Chuck Ingoglia, MSWSenior Vice President, Public Policy and Practice Improvementchucki@thenationalcouncil.org

202.684.3749