HHS Sec Sylvia Burwell meets with Behavioral Health Stakeholders and invites an agenda for the final two Obama years

On Friday, February 27, our Behavioral Health Stakeholder Group was privileged to meet with HHS Secretary Sylvia Burwell and SAMHSA Administrator Pam Hyde to discuss major current needs in the mental health and substance use care fields. In a spirited discussion with the Secretary, four areas were highlighted and needs identified: the Affordable Care Act and Parity; Care Integration and Value Purchasing; the Opioid Issue; and Workforce Needs.

Affordable Care Act (ACA) and Parity. Clearly, an urgent need exists to implement federal parity requirements and to assure that parity guidelines are being followed by all states. To do this effectively, HHS needs to release its regulations on parity in Medicaid Programs, and HHS needs to work with states and counties to assure full implementation. Further, a major effort will be needed by HHS to help persons with mental health and substance use conditions enroll in ACA Medicaid and Marketplace health insurance over the final two years of the Obama Administration. Finally, in just a few short months, the ACA Essential Health Benefit will be reviewed by HHS, and both the mental health/substance use benefit and the medication benefit will require adjustments going forward.

Care Integration and Value Purchasing. The ACA is making radical changes to the landscape in which behavioral healthcare operates, including rapid movement toward integrated health homes and integrated medical homes. At the same time, Secretary Burwell just announced a few weeks ago a major initiative on value purchasing for Medicaid and Medicare, which will be implemented over the next two years.

Value purchasing will involve major change from our current encounter-based reimbursement system to integrated case and capitation rates, adjusted through the use of performance measures. As a result of these changes, an immediate need exists for HHS to provide help to the field on care integration and value purchasing after a limited set of specific information and technical assistance needs are identified. Further, the Secretary will need to change regulatory guidelines so that federally-qualified health centers (FQHCs) and behavioral health centers can work effectively together. As FQHCs develop behavioral healthcare capacity, it will be very important that this capacity is developed collaboratively with local counties and behavioral health centers. Finally, all programs will need to incorporate important and exciting new developments in the field, including early intervention for first-episode psychosis.

The Opioid Issue. This issue is very urgent; each year, more than 17 thousand Americans die from opioid overdoses, and an additional 8 thousand, from heroin overdoses. The field needs immediate assistance from HHS to confront this stark reality. Resources are needed so that nalaxone, the principal antidote to opiod overdoses, is made available in every US community. Funds from the Substance Abuse Prevention and Treatment Block Grant and the Community Mental Health Services Block Grant are needed to provide essential treatment and prevention services. And Medicaid and private insurance resources are needed to fund medication-assisted treatment (MAT), a new evidence-based practice.

Workforce Needs.  Implementation of the ACA is accentuating the dire shortages of behavioral health personnel to provide needed specialty services. Specifically, we expect the size of the behavioral healthcare system to double in the next 10 years, at the same time that behavioral healthcare in primary care settings also grows dramatically. Fortunately, we have an excellent peer support workforce available for this work, which is currently reimbursable in about three quarters of the states. HHS will need to extend this reimbursement to FQHCs, health homes, and medical homes as care integration expands.

Further, a related need exists to increase the number of behavioral health trainees in the National Health Services Corps (NHSC), and to expand loan forgiveness for providers from all behavioral health disciplines who continue to work in public and not-for-profit settings. Finally, a more targeted workforce need is to assure that behavioral health providers and programs are equipped to deal with an ever-expanding suicide risk. Currently, about 40 thousand Americans commit suicide each year, including 23 veterans every day.

As a follow-up to our meeting with Secretary Burwell and Administrator Hyde, the Behavioral Health Stakeholder Group was asked to provide a list of 10 key recommendations for action that the Secretary and the Obama Administration could undertake to advance behavioral health work.  In addition to the key actions identified above, the group also recommended immediate efforts to support the social safety net and a longer-term campaign to better understand community culture and how to promote strength-based approaches in communities.

Our hats are definitely off to Secretary Burwell and to Administrator Hyde for inviting dialogue with the Behavioral Health Stakeholder Group and for willingness to entertain a bold agenda for the final two years of the Obama Administration. I am sure that I speak for our entire group when I say how appreciative we are to both of them for their outreach, their effort, and their obvious commitment to our work.