黑料正能量 Note: Coordination between advocates and agencies at the Federal level has yielded top recommendations for focus from HHS and SAMHSA for the remainder of the current presidential administration. These recommendations will be reviewed by Secretary Burwell and may be implemented through initiatives that could spur funding at the state level, particularly for the policy and program work toward integration and enhancement of substance abuse services. See the recommendations below:
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Field Encouraged by Federal Interest in Addressing Key Behavioral Health Issues
Mental Health Weekly; Vol 25 Num 11, 3/16/2015
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With 听only 听22 months left 听in 听the Obama administration, the field 听is optimistic about ramping up the behavioral health agenda following 听a meeting February 27 with 听Health and Human Services 听(HHS) Secretary 听Sylvia Burwell 听and 听a 听subsequent submission of key recommendations, including parity implementation听听 and 听addressing workforce needs, that could go a long way toward 听impacting the mental health and substance use disorder arena.
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During 听the meeting with 听Burwell and Substance Abuse and Mental 听Health 听Services Administration (SAMHSA) Administrator Pam Hyde, the Behavioral Health Stakeholder Group 听highlighted 听four 听areas: the Affordable Care Act (ACA) and parity, care integration and value purchasing, the opioid issue, and workforce needs.
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Following the meeting, the group was asked by a member of Burwell鈥檚 staff to submit 10 key recommendations for 听action that the secretary and the Obama administration could undertake 听to 听advance behavioral health work. The preparation of the recommendations submitted March 2 was spearheaded by Ron Manderscheid, Ph.D., executive director of the National Association of County Behavioral Health and Developmental Disability 听Directors; Robert 听Morrison, executive director of 听the 听National Association of 听State Alcohol 听and Drug Abuse Directors; Robert Glover, Ph.D., executive director of the National Association of State Mental Health Program Directors; and Paul Samuels, 听director and president of the Legal Action Center.
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The resulting list builds upon the work 听of the group, including input from 听27 听organizations, conducted over 听the听 听weekend 听following听 听the meeting. 鈥淲e consulted with as many groups as possible 听for input into this process,鈥 Manderscheid told MHW.
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The most important item on the list, 听and 听one 听that 听should 听be 听addressed immediately, Manderscheid said, is 听to 听maintain听 and 听increase funding for the Community Mental Health 听Services Block 听Grant 听and Substance Abuse听 听and 听Prevention Treatment Block Grant in order to address the needs of people who remain uninsured and provide for critical health services and the social wraparound services not covered by the ACA.
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Manderscheid noted 听that 听the willingness of federal leaders to invite 听dialogue about mental health and substance use disorder issues is unlike anything he鈥檚 seen during his whole career in D.C., in a Republican or 听Democratic administration. 鈥淭his is a wonderful 听opportunity,鈥 said Manderscheid. 鈥淭he secretary is fully engaged in 听mental health and SAMHSA responded 听to an interview request by MHW by releasing the following 听statement: 鈥淭he Administrator continues to have follow-up conversations with the Secretary and her team, including senior officials at HRSA [Health Resources and Services Administration] 听and 听CMS [Centers for 听Medicare & 听Medicaid Services]. There is a strong commitment at the highest levels to making significant progress on 听the 听issues raised. 听Opioids, 听Care听 听Integration and 听Payment 听Reform, 听Parity, 听and Workforce are areas of shared interest and urgency.鈥
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Highest-priority needs
鈥淭hese 10 recommendations 听are deemed important by members of the group and we鈥檙e waiting to see which 听ones are the highest priority to the secretary,鈥 Glover told MHW. 鈥淪afety net funding and ensuring the active enforcement of parity are essential. This is an exceptional opportunity.鈥
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鈥淲e really appreciate the very strong 听commitment 听the 听secretary has for addressing the needs of people 听with 听mental 听health 听and 听substance use 听issues,鈥 Samuels told MHW. 鈥淭he secretary was very engaged and very 听serious about finding out what the needs and concrete steps are to be taken during the time that鈥檚 left in the administration.鈥
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The ACA and federal parity laws will present greater opportunities to provide services to many millions at risk or 听who have mental health or substance use disorders, said Samuels. Many health plans are not 听in compliance with ACA and parity law requirements, he added.
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鈥淲e have a short window to revamp the service delivery system,鈥 said Samuels. 鈥淭here鈥檚 听also an epidemic of opioid use spreading over the country,鈥 he said. There are real large increases of opioid misuse and heroin over the last couple of years, and it鈥檚 critically important that the government responds to this effectively, said Samuels. 听The 听secretary was very serious about these issues and 听committed 听to 听a 听prompt 听response, added Samuels.
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Recommendations
Below are excerpts of the recommendations submitted to Secretary Burwell听 by the Mental Health and 听Substance Use Disorder Stake- holder Group to be addressed over the next 22 months:
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Affordable Care Act/parity
- 鈥淭he Center for Consumer Information and Insurance Oversight (CCIIO) should 鈥 issue guidance听听 听regarding听听 听lawful compliance with 听the requirements of the ACA and Mental Health 听Parity 听and 听Addiction Equity 听Act, 听regarding 听both quantitative and nonquantitative 听treatment limitations, including听 听issuing听 听final听 听parity regulations 听for 听Medicaid 听as quickly as possible; and conducting a review of all essential health benefits packages.
- 鈥淔acilitate enrollment of people 听with 听untreated MH/SUD and minimize interruptions of coverage and care by 鈥 working 听with 听the 听Department of Justice in providing guidance to states and localities in order to听 听facilitate 听enrollment 听and linkage to mental health, substance use disorder and physical care of 听everyone in 听the criminal听听 justice 听system, including 听ceasing the termination of Medicaid of those who are incarcerated.鈥︹
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Care 听integration/value 听purchasing/delivery 听system 听reform
- 鈥淧rovide practical models and examples of 听delivery听 system reform听 听initiatives, 听including those that incorporate social wraparound services, 听so that state, county and city mental health and substance use disorder provider entities can undertake key steps to foster reforms that will 听lead to good integrated care.鈥
- 鈥淔acilitate operational planning and reforms so that more effective working relationships can be 听developed 听between 听MH/SUD听 providers 听and 听primary and physical health care providers, specifically FQHCs [federally qualified health centers].鈥
- 鈥淗HS has a critical window in the next two years to catalyze national听 听implementation听 听of first-episode听 听psychosis 听programs. The National Institute of Mental Health (NIMH) has invested significant resources, and 听data will听 听be 听published this summer on clinical trials for these programs.鈥
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Opioid/heroin problem
- 鈥淚ncrease funding for SAMHSA to help states, counties and localities 听purchase 听naloxone. Target funding 听to听 听the 听substance use disorder care system (state/county/local agencies, providers, families and recovery community).鈥
- 鈥淢aintain and increase support for 听treatment and prevention services addressing opioids and other drugs 鈥 including medication-assisted 听treatment. Provide additional funds for all effective treatments and prevention interventions.鈥
Workforce
- 鈥淐ontinue and expand Medicaid 听reimbursement for 听certified peer support specialists, including 听family听 听and 听youth peers,听听 听addiction听听 听recovery coaches and health navigators; incentivize states to establish this access; and streamline the ability of physical health entities, 听including听 听FQHCs 听and emergency departments, to directly bill for these services.鈥
- 鈥淓xpand听听 听loan听听 听forgiveness, scholarship, 听fellowship听 听and other workforce initiatives for MH/SUD听 听practitioners, 听such as psychiatrists, 听psychologists, 听social workers, mental health nurse practitioners, 听marriage and family therapists, licensed counselors, certified 听alcohol and 听drug 听abuse counselors, addiction medicine specialists, certified prevention specialists and 听peer 听specialists, to 听increase the 听availability 听of 听licensed clinicians and improve recruitment and retention.鈥
- 鈥淓ncourage the 听Health 听Resources and Services Administration and SAMHSA 听to take measures to 听promote systematic implementation of Suicide Prevention and 听the 听Clinical Workforce:听听 听Guidelines听听 听for Training, 听established by 听the Clinical Workforce听 Preparedness Task Force of the National Action 听Alliance 听for Suicide Prevention.
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