National Policy Update—Parity, Healthcare Reform and Beyond

Legal Action Center

July 11, 2010

Tremendous Opportunity for Expansion of Coverage for Addiction Treatment

• The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA)– Represents greater understanding of addiction as treatable

chronic health condition– Now in effect– Statute and regulations to guide implementation

• The Patient Protection and Affordable Care Act (PPACA)– Identification of substance use prevention and addiction

treatment as health care – Expansion of coverage of treatment in both private and public

insurance– Inclusion of addiction services and the addiction service

workforce in broader initiatives to strengthen health care

Implementing Parity: Work Nationally and in the States

• Focus on Parity in Washington:– Additional guidance from federal regulators?

• Scope of services• Work with Centers for Medicare and Medicare

Services (CMS) re: Medicaid managed care plans• Continued legal challenges• Engaging our Congressional champions• Monitoring compliance and encouraging strong

federal activity and response

Implementing Parity: Work Nationally and in the States (cont’d)• Focus at the State Level:

– Continued work with state policy-makers• Intersection with state laws

– Additional challenges to the law• Fighting violations of both the letter and spirit of the

law

– Tremendous need for education to ensure compliance

Implementing Healthcare Reform

– Key areas of focus:• Services in minimum benefit package• Changes to Medicaid and Medicare• Intersection with parity• Work with primary care• Models of care• Prevention• Recovery support services• Workforce and other service delivery issues• Health information technology

Implementing Healthcare Reform: Work in Washington

– Enormous scope of the regulatory process—moving forward quickly!

– Focus at SAMHSA and ONDCP:• Educating HHS (CMS, HRSA) and other key agencies about our

world• SAMHSA’s leadership on healthcare reform: working internally and

with stakeholders to first determine what people need—then who should purchase which services

• Defining the essential benefit package• Areas needing additional analysis/clarity: prevention, recovery

supports, adult residential treatment and adolescent services• Discussions about improving coordination of addiction, mental

health and primary health care—integration?• Conversations about potential changes to purposes of existing

funding streams in light of healthcare reform• Timing• Dollars to align with priorities in current funding environment?

Focus of Our Advocacy in the Implementation Process

• Implementing the parity and healthcare reform laws:– Ensuring that addiction experts are at the table—nationally and at the

state level– Developing specific recommendations and advocating for their inclusion

—cohesion of the field– Continuing to serve as a resource to decision-makers– Engaging our Congressional champions in the regulatory process—

continued outreach and education– Anticipating arguments against full inclusion and gathering/bolstering

what we need – Protecting the healthcare safety net—the SAPT Block Grant and other

key programs– Sustaining support for strategies/interventions/services not covered by

the new law– Continuing to fight for stronger protections for people in need of care

and supports