medicaid, medicare, mental health, healthcare

1. Reforming The Nation's Mental Health System
As healthcare reform is becoming a reality, there is much to celebrate within the mental health
community. This includes passage of a healthcare reform package that includes parity for mental
health and addiction services, expansion of Medicaid to 133 % of Federal Poverty Level, inclusion
of behavioral health organizations and individuals with mental illnesses in the new Medicaid
medical home state option, and authorization and increased funding for grants co-locating mental
health treatment and primary care. These and a host of other provisions expand the opportunities
for individuals with mental illnesses and addictions to obtain and maintain insurance coverage and
access needed services.
But this is not the end of the mental healthcare battle. Simply put, mental health advocates must
be ready to play in a new game, in a world where increasing numbers of individuals - by virtue of
Medicaid expansion, the emerging Health Insurance Exchanges, and parity regulations - will have
access to behavioral health services. We expect to see an additional 15 million individuals - an
increase of 43 % - eligible for Medicaid alone, with more than 30 million individuals overall who
will, in the not too distant future, have insurance coverage.
But this is far more than a matter of numbers - it's about working smarter. Advocates of mental
healthcare anticipate that healthcare reform-driven service delivery redesign and payment reform
will unfold at a rapid pace. In order to bend the cost curve, payment reform and service delivery
redesign will change how health, mental health, and substance use services are integrated,
funded, and managed. Providers must learn to practice healthcare the way healthcare will be
done.
As mental healthcare providers and advocates, we must become savvy about positioning
ourselves to take advantage of new markets and new opportunities to help control the design and
delivery of healthcare services. We must begin to build relationships within and across the entire
healthcare sector. As we revisit the concept of "managing care" for individuals and whole
populations, we have to be certain that our focus on person-centered, recovery-focused treatment
and services is not subsumed by the drive to "bend the curve" in healthcare costs. We must be
able to demonstrate our value not only to our customers, but also as key players in these new
healthcare consortia.
We must become accountable for efficient and effective services that show results across all
health domains. We believe fee-for-service reimbursement will slowly become a thing of the past.
So, too, will be the ability to claim that caseloads are full with no-show rates of 50 % and more. We
risk being left on the sidelines if we don't move with deliberate speed to ensure continuity and
timely access to care; comply with third-party payer requirements; coordinate care with a full range
of health providers; and if necessary take on payers that refuse to honor the spirit and letter of the
parity regulations.

2. We must become increasingly customer-focused, from the way we greet individuals who come
through our door to the way we market our services. We should expect that with more money
available in healthcare - particularly for mental health and addiction treatment - that new and well
capitalized players will find behavioral health, traditionally a financially unattractive healthcare
sector, far more appealing.
People will be insured and will have an increasing range of options available to them. What
differentiates our mental healthcare services? Why should an individual choose to receive
treatment and support from us? Are we offering services that will help them meet a full range of
healthcare needs? Are our services culturally appropriate for the communities we serve? Can we
help them understand and make appropriate use of their insurance coverage? We must retool our
organizations with the knowledge that all individuals will now become true "consumers" of
healthcare services.
At the same time, we must also be aware that our work is far from over at the state and federal
level. Forty eight of 50 states are experiencing severe budget shortfalls. The threat is very real and
the mental healthcare advocates are fighting hard to hold on to current funding as legislatures see
an opportunity to continue to withdraw needed funds. This is surely a bad idea - even the most
generous healthcare benefits will likely not cover the full range of wraparound supports that people
with mental illnesses and addictions need to fully recover.
Due to greater understanding of how many Americans live with mental illnesses and addiction
disorders and how expensive the total healthcare expenditures are for this group, we have
reached a critical tipping point when it comes to healthcare reform. We understand the importance
of treating the healthcare needs of individuals with serious mental illnesses and responding to the
behavioral healthcare needs of all Americans. This is creating a series of exciting opportunities for
the behavioral health community and a series of unprecedented challenges mental-health
organizations across the U.S. are determined to provide expertise and leadership that supports
member organizations, federal agencies, states, health plans, and consumer groups in ensuring
that the key issues facing persons with mental-health and substance use disorders are properly
addressed and integrated into healthcare reform.
In anticipation of parity and mental healthcare reform legislation, the many national and community
mental health organizations have been thinking, meeting and writing for well over a year. Their
work continues and their outputs guide those organizations lobbying for government healthcare
reform.
MENTAL HEALTH SERVICE DELIVERY
1. Mental Health/Substance Use Health Provider Capacity Building: Community mental health and

3. substance use treatment organizations, group practices, and individual clinicians will need to
improve their ability to provide measurable, high-performing, prevention, early intervention,
recovery and wellness oriented services and supports.
2. Person-Centered Healthcare Homes: There will be much greater demand for integrating mental
health and substance use clinicians into primary care practices and primary care providers into
mental health and substance use treatment organizations, using emerging and best practice
clinical models and robust linkages between primary care and specialty behavioral healthcare.
3. Peer Counselors and Consumer Operated Services: We will see expansion of consumer-
operated services and integration of peers into the mental health and substance use workforce
and service array, underscoring the critical role these efforts play in supporting the recovery and
wellness of persons with mental health and substance use disorders.
4. Mental Health Clinic Guidelines: The pace of development and dissemination of mental health
and substance use clinical guidelines and clinical tools will increase with support from the new
Patient-Centered Outcomes Research Institute and other research and implementation efforts. Of
course, part of this initiative includes helping mental illness patients find a mental health clinic
nearby.
MENTAL HEALTH SYSTEM MANAGEMENT
5. Medicaid Expansion and Health Insurance Exchanges: States will need to undertake maor
change processes to improve the quality and value of mental health and substance use services
at parity as they redesign their Medicaid systems to prepare for expansion and design Health
Insurance Exchanges. Provider organizations will need to be able to work with new Medicaid
designs and contract with and bill services through the Exchanges.
6. Employer-Sponsored Health Plans and Parity: Employers and benefits managers will need to
redefine how to use behavioral health services to address absenteeism and presenteeism and
develop a more resilient and productive workforce. Provider organizations will need to tailor their
service offerings to meet employer needs and work with their contracting and billing systems.
7. Accountable Care Organizations and Health Plan Redesign: Payers will encourage and in some
cases mandate the development of new management structures that support healthcare reform
including Accountable Care Organizations and health plan redesign, providing guidance on how
mental health and substance use should be included to improve quality and better manage total
healthcare expenditures. Provider organizations should take part in and become owners of ACOs
that develop in their communities.
MENTAL HEALTHCARE INFRASTRUCTURE

4. 8. Quality Improvement for Mental Healthcare: Organizations including the National Quality Forum
will accelerate the development of a national quality improvement strategy that contains mental-
health and substance use performance measures that will be used to improve delivery of mental-
health and substance use services, patient health outcomes, and population health and manage
costs. Provider organizations will need to develop the infrastructure to operate within this
framework.
9. Health Information Technology: Federal and state HIT initiatives need to reflect the importance
of mental-health and substance use services and include mental-health and substance use
providers and data requirements in funding, design work, and infrastructure development. Provider
organizations will need to be able to implement electronic health records and patient registries and
connect these systems to community health information networks and health information
exchanges.
10. Healthcare Payment Reform: Payers and health plans will need to design and implement new
payment mechanisms including case rates and capitation that contain value-based purchasing
and value-based insurance design strategies that are appropriate to provide the best drug rehab
for persons with mental health and substance use disorders. Visit this website to get in touch with
Non 12 step drug rehab programs in your area. Providers will need to adapt their practice
management and billing systems and work processes in order to work with these new
mechanisms.
11. Workforce Development: Major efforts including work of the new Workforce Advisory
Committee will be needed to develop a national workforce strategy to meet the needs of persons
with mental health and substance use disorder including expansion of peer counselors. Provider
organizations will need to participate in these efforts and be ready to ramp up their workforce to
meet unfolding demand.