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Substance Use Disorder

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On February 8, the Department of Human Services (DHS) Secretary Ted Dallas announced the availability of onboarding grant funds to help connect hospitals and ambulatory practices to the Authority’s Pennsylvania Patient & Provider Network, or P3N.

The P3N enables electronic health information exchange (eHIE) across the state through the connection of health care providers to health information organizations (HIO), and the participation of the HIOs in the P3N.

“These grants will assist providers in the efficient delivery of quality services to the individuals we serve across the commonwealth,” said DHS Secretary Ted Dallas. “As more providers participate, individuals will experience better coordination of care and a better quality of health care.”

The grant program, available to Pennsylvania HIOs to enable the connection of inpatient hospital/facilities and outpatient practice or other outpatient provider organizations participating in the Medicaid Electronic Health Records (EHR) Incentive Program, includes:

  • Up to $75,000 to connect each eligible inpatient hospital or other inpatient facility to an HIO;
  • Up to $35,000 to connect each eligible outpatient practice or other outpatient provider organization to an HIO; and
  • Up to $5,000 to enable other eligible providers that do not fit into the two categories above, but want to enable HIE participation and connect to an HIO via a portal.

Each eligible provider will connect via an HIO to the P3N.

Only a single award is permitted to any one hospital/facility or outpatient practice. The anticipated performance period for this grant runs through September 30, 2017.

The grant will:

  • Help providers deliver higher quality and more efficient care, particularly through better care coordination for patients covered by Medicaid;
  • Support provider participation in private-sector HIOs by offsetting connection costs;
  • Incentivize HIOs to join the P3N, a precondition for receiving funding;
  • Support rapid movement toward the participation in eHIE, and support various care reform efforts currently underway across the Commonwealth; and
  • Defray up-front costs for individual providers to join an HIO, thus helping to achieve meaningful use and satisfy obligations under the Medicaid EHR Incentive Program.

This program will be made possible through an $8.125 million grant from the federal Centers of Medicare & Medicaid Services (CMS). Under the terms of the federal grant, CMS will provide 90 percent of the onboarding grant, with the remaining 10 percent funded by the Commonwealth. The grant applications and supporting materials are available online here.

(Information courtesy of DHS)

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The number of adults in the United States aged 65 and older is expected to exceed 82 million by 2040. Approximately 16 million of these older adults will have a mental health or substance use condition and they will be turning to their primary care providers for care. Join this webinar to learn what integrated health care practitioners, especially primary care providers, need to know to be prepared to meet behavioral health needs of the older adults they serve. Learn how one primary care provider took steps to identify and address behavioral health concerns in older adults and hear how integrated primary and behavioral health care can guide patients toward healthy aging.

The SAMHSA-HRSA will host a webinar on Wednesday, February 15, at 1:00 pm on this topic of growing importance. Primary care providers and behavioral health professionals can register for free here.

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A new report finds that there have been substantial gains on the issue of making addiction and mental health coverage equal to physical health coverage. Much work still needs to be done, especially for children, according to Ron Manderscheid, PhD, Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD) and the National Association for Rural Mental Health. “Children can’t speak for themselves on the issue of parity,” Manderscheid says. “That’s why it’s very important for the Department of Health and Human Services (HHS) and state health insurance commissioners to protect the rights of children around parity. Any child who has health insurance coverage through the individual marketplace under the Affordable Care Act (ACA), or through the ACA’s Medicaid expansion, is entitled to parity protection, but we don’t really know how well it’s working.” The estimated 8.4 million children enrolled under the Children’s Health Insurance Program, which is part of Medicaid, are not covered by parity protections, Manderscheid noted. “The field has so focused on problems with implementing parity with adults that children haven’t gotten equal attention in this process.” In October, the White House Mental Health and Substance Use Disorder Parity Task Force issued a report that concluded that overall, state-level substance use disorder parity laws have helped to increase the treatment rate by approximately 9 percent across substance use disorder specialty facilities and by about 15 percent in facilities that accept private insurance. This effect was found to be more pronounced in states with more comprehensive parity laws.

“The concept of parity is simple, but the implementation of it is incredibly complex,” said Manderscheid. The trickiest part of parity is a concept called non-quantitative treatment limitations, which are processes that managed care firms use to determine who will and won’t get care, he explains. Currently, the burden chiefly falls on the consumer to report to the federal or state government if their claims for addiction or mental health treatment are denied. “The enforcement burden should fall on HHS, state insurance commissioners, and the insurance companies themselves.”

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Governor Wolf announced Tuesday afternoon that Gary Tennis, Secretary of the Department of Drug and Alcohol Programs (DDAP), will no longer hold that position. The governor did not state a reason for Tennis’ departure; RCPA will report any further details as they become available. Deputy Secretary Jen Smith will serve as Acting Secretary. View the governor’s official press release here.

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In recent months, Pennsylvania’s Learning Community has focused on challenges to financing and payment for mental health care in the primary care and collaborative care settings. The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) has provided the field with an array of information, presentations, and other resources related to the financing of mental health services in primary care and integrated care settings. Below are some of the resources that CIHS has made available to us here in Pennsylvania.

  • The ability to bill for both behavioral health and primary care services on the same day is an essential part of integrating care. The Center for Medicare and Medicaid Services (CMS) created the Billing Properly for Behavioral Health Services booklet to help providers understand the laws and regulations that govern billing for behavioral health services.
  • The resource also includes a checklist to help evaluate your billing procedures and identify potential errors, as well as a resource guide for your billing staff to review current guidelines, billing and coding, covered services, and compliance information.
  • Learn ways you can enhance and streamline your billing process through Improving Your Third-Party Billing System, a self-paced online course from SAMHSA’s BHbusiness initiative.

CIHS continually updates its website to present the best and newest resources and information relevant to integrated primary and behavioral health care.

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From: “HS, Secretary’s Office”
Date: January 5, 2017 at 1:01:56 PM EST
To: “[email protected]”
Subject: [DHS-STAKEHOLDERS] DHS Awards Medicaid Agreements

Department of Human Services (DHS) Secretary Ted Dallas announced that DHS has agreed to move forward and negotiate agreements with six managed care organizations (MCOs) to deliver physical health services to Pennsylvanians through HealthChoices, Pennsylvania’s mandatory Medicaid managed care program since 1997.

“These agreements will be the most significant changes to Pennsylvania’s Medicaid program since we moved to managed care two decades ago,” said Dallas. “Over the next three years, MCOs will be investing billions of dollars in innovative approaches that reward high-quality care that improves patient health rather than just providing services for a fee.”

The $12 billion, three-year contracts include a 30 percent target for payments based on value received or outcomes, rather than on the quantity of services provided.

The MCOs were selected based on several criteria, including their current performance, the level of customer service delivered, member satisfaction, and their value-based performance plan. Performance criteria measured, among other things, management of chronic conditions such as high blood pressure, diabetes, and asthma; frequency of prenatal and post-partum care; and access to preventive services.

“The average performance ratings of the selected organizations are consistently higher than the current averages in every region. This transition will result in higher levels of quality care for the 2.2 million Pennsylvanians served by Medicaid,” said Dallas.

To drive Pennsylvania’s Medicaid system towards these better outcomes, the three-year agreements set gradual targets for all MCOs to increase the percentage of value-based or outcome-based provider contracts they have with hospitals, doctors, and other providers to 30 percent of the medical funds they receive from DHS. The result will be that billions in funds that would have otherwise been spent on traditional payment arrangements will instead be invested in outcome or value-based options such as:

  • Accountable care organizations (voluntary networks of hospitals, doctors, and other providers that work together to provide coordinated care to patients);
  • Bundled payments (increases value-based purchasing);
  • Patient-centered medical homes; and
  • Other performance-based payments.

“We’re going to reward folks for providing the right services, not just more services. You get what you pay for so we’re shifting the focus of Pennsylvania’s Medicaid system toward paying providers based on the quality, rather than the quantity of care they give patients,” said Dallas. “In addition, by focusing on improving the health of consumers, we will drive down the cost of care and ultimately save the taxpayer funds we spend on health care in Pennsylvania.”

HealthChoices delivers quality medical care and timely access to all appropriate services to 2.2 million children, individuals with disabilities, pregnant women, and low-income Pennsylvanians.

For more information, visit www.HealthChoicesPA.com or www.dhs.pa.gov.

DHS has selected the following MCOs to proceed with negotiations to deliver services in Pennsylvania beginning in June 2017. The agreements are awarded in five geographic regions:

Southeast Region Gateway Health
Health Partners Plans
PA Health and Wellness
UPMC for You
Vista–Keystone First Health Plan
Southwest Region Gateway Health
PA Health and Wellness
UPMC for You
Vista—AmeriHealth Caritas Health Plan
Lehigh/Capital Region Gateway Health
Geisinger Health Plan
Health Partners Plans
PA Health and Wellness
Northeast Region Gateway Health
Geisinger Health Plan
UPMC for You
Northwest Region Gateway Health
UPMC for You
Vista—AmeriHealth Caritas Health Plan

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The opioid crisis in Pennsylvania and in America has resulted in a major call to action from Pennsylvania’s leadership as well as national leaders. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health calls for increased integration of primary care and addiction services. Join one of the authors of the report, Dr. Connie Weisner, in a discussion of the findings and what efforts are needed to support integrating screening, assessments, interventions, use of medications, and care coordination. Hear practical examples from an HRSA-funded primary care provider about the steps they take to successfully and continually address substance use.

The SAMHSA-HRSA Center for Integrated Health Solutions will host a webinar focusing on the substance use and opioid crisis and coordinated care on Thursday, January 5, 2017, 3:00 pm.

After this webinar, participants will:

  • Understand the key findings related to integration of substance use and primary care services detailed within The Surgeon General’s report on Alcohol, Drugs and Health;
  • Identify concrete ways primary care settings can integrate substance use treatment and early intervention activities into their services;
  • Describe why early intervention activities such as SBIRT are important to overall health;
  • Gain ideas for using the report to educate staff, board, and clients to facilitate conversation about addictions; and
  • Learn about useful resources for setting up and providing substance use services in an integrated health setting.

Register here →

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The Integration Edge is a new resource from the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) that outlines practical tips and examples from organizations that have been working to integrate primary and behavioral health care. CIHS has been exploring partnerships, confidentiality issues, and sharing information and data-driven care. CIHS will regularly update The Integration Edge with new topics and practical examples. Whole person, health care focused practitioners and provider organizations looking for additional advice or with a topic they would like to see highlighted can visit this new website or contact CIHS by phone 202-684-7457 or email.

Know about the latest topics as they are added to The Integration Edge when you sign up for the email as the center adds new topics and other news related to integration.

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Patrick Kennedy, former United States Representative and founder of the Kennedy Forum, has issued an open letter to the heads of the leading insurance companies in response to the findings of last week’s Surgeon General’s report. The report, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, addresses a broad array of issues, ranging from illicit drug abuse to prescription drug addiction, alcohol use, binge drinking, and teen alcoholism. Mr. Kennedy’s letter urges the commercial nation’s health industry to take action in five key areas:

  1. Eliminate the onerous medical management practices responsible for inadequate, ineffective treatment of addiction;
  2. Immediately ensure that all plans cover and reimburse for well-supported medication-assisted treatment (MAT), including buprenorphine, buprenorphine-naloxone, buprenorphine-hydrochloride, methadone, naltrexone, acamprosate, and disulfiram, at rates equal to coverage for medications used to treat other forms of chronic illness;
  3. Incentivize greater coordination of care;
  4. Adequately disclose processes for ensuring parity compliance;
  5. Promote screening and work with communities to implement prevention interventions.

Each of these requests is clarified in further detail in the letter. Patrick Kennedy was the prime sponsor of the Mental Health Parity and Addiction Equity Act of 2008 and author of the book, A Common Struggle (Blue Rider Press/Penguin Random House, 2015).

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