Although the last Congress was criticized for lack of action, it got quite a bit done on behavioral health, including passage of the Excellence in Mental Health Act and funding for mental health first-aid training. But those are just first steps, and they require lots of follow-up work. Likewise, as the Affordable Care Act (ACA) implementation continues to roll out, behavioral health executives will monitor how it impacts their practices. Behavioral Healthcare asked policy thought leaders to talk about which issues they believe will be top priorities in 2015.
1 Parity Regulation and Enforcement
The top policy issue that will unfold in 2015, observers say, involves parity enforcement now that the rules are on the books. Final regulations of the Federal Mental Health Parity and Addictions Equity Act went into effect in January, but all eyes will be on state insurance commissioners as they monitor compliance among health plans. In 2015, the Centers for Medicare and Medicaid Services (CMS) also is expected to release new guidelines regarding parity in the Medicaid managed care market. Providers should watch for the proposed rules to be published by CMS early in 2015, with a comment period before the final rule is published later in the year.
“With final rules just going into effect, it is going to take several years for the full effects of parity to play out,” says Charles Ingoglia, senior vice president of public policy and practice improvement for the National Council for Behavioral Health.
Federal officials with SAMHSA and CMS have spent time with state insurance commissioners trying to answer their questions and provide technical assistance. The Parity Implementation Coalition and the Coalition for Whole Health also have parity on the radar, he says, adding that there will likely be more class-action lawsuits against insurers that fail to meet requirements.
“Parity is our single largest issue now,” agrees Scott Munson, executive director of Sundown M Ranch, an alcohol and drug treatment facility in Selah, Wash., and a board member of the National Association of Addiction Treatment Professionals (NAATP). “It is going to play out in a state-by-state process.”
He says his organization is watching how proactively federal regulators are overseeing state-level enforcement.
The CMS guidance as to how the federal parity law applies to Medicaid managed care will be crucial for treatment centers that serve the population, especially in states with Medicaid expansion, Ingoglia says.
“We expect for most public-sector providers, that is a much more pertinent issue than the implementation of parity in the commercial space,” he says.
Mary Fleming, director of the Office of Policy, Planning, and Innovation at the Substance Abuse and Mental Health Services Administration (SAMHSA), says that it will take several years to work through the practical implementation of parity regulations from the federal level all the way down to local communities.
“We use our network of regional administrators to provide information on what is happening in various states,” she says, “but enforcement will require action on the part of several federal partners and at the state level.”
2 Excellence in Mental Health Act
One key policy move this year was set up by the April 2014 passage of the Excellence in Mental Health Act. It creates criteria for “certified community behavioral health clinics” as entities designed to serve individuals with serious mental illnesses and substance use disorders to ensure a range of services is available. The act permits pilots to begin this year in eight states that could be replicated nationwide after the two-year pilot phase.
“Historically community mental health centers have been funded at a lower rate than other providers,” SAMHSA’s Fleming says. “The act will provide a way to more equitably fund community mental health centers while still focusing on treatment outcomes.”
Ingoglia says the act is important for several reasons, including the fact that it promises to create standards at federal and state levels about what type of care should be available to people with serious mental illnesses.
“I can’t remember the last time Congress made a $1.1 billion investment in behavioral health. It just doesn’t happen very often,” he says. “This is one of the most significant things that has been lacking in our country: There has been no sense of what the standard of care is. That has led to incredible variation around the country, and there is no excuse for that.”
SAMHSA, NIH and others have invested millions of dollars determining effective practices for particular populations, and yet the availability of those services is highly variable by state and county.
“So this would create some infrastructure,” he says. “But more importantly it also brings with it federally defined reimbursement to make those standards a reality.”
Later this year states will begin applying for the $25 million in planning grants for the two-year demonstration program. Fleming says providers who are interested in participating should get engaged now at the state level.
“It will require the state Medicaid director to agree to be the grantee,” she says. “Local treatment facilities should be working through their associations or other groups to influence the states.”