Are you ready for the major changes of the Affordable Care Act that will go into effect in 2012? At the National Council’s annual conference, to be held this year April 15-17 in Chicago, we have a full line-up of sessions to help you make the most of the changes ahead – and to learn from presenters that have already hit “health reform home runs” in their states. Our sessions include:

• Getting it Done: What’s Next for Reform
• The Non-Wonk’s Guide to Health Reform
• Missouri “Show Me” How to Build a Health Home
• How to Hit a Health Reform Home Run: One Behavioral Health Center’s Story of Reinvention
• Fixing America’s Healthcare System: The Rural Oregon Approach
• Creating the One-Stop Healthcare Neighborhood in Atlanta, Georgia
• And much more!

Visit our website to view the preliminary program, check out our roster of influential and exciting keynote speakers, and register to get our lowest rates.

The Department of Health and Human Services (HHS) in December issued an information bulletin outlining how it intends to approach its task of creating an Essential Health Benefits (EHB) package under health reform. When finalized, this policy will have a significant impact on the services available through both public and private health insurance plans because it establishes the minimum benefits that health plans must cover beginning in 2014.

Rather than define one package at the federal level, the HHS bulletin proposes to leave considerable discretion to the states in crafting their own EHB packages. This week, the National Council submitted its comments on the HHS proposed approach. Our comments express our concern that the December bulletin does not include sufficient protections to ensure adequate access to mental health and substance use disorder treatment services. We offer recommendations to HHS on strengthening its EHB guidance by: developing and enforce safeguards to ensure that affording state flexibility for development of EHB plans does not undermine access to care; establishing stronger oversight for Parity implementation and adherence; ensuring adequate health insurance coverage for children by requiring states to mirror Medicaid’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefits when they establish the EHB plans; defining rehabilitation and habilitation benefits so as to explicitly include services to maintain, as well as improve, daily functioning; and more.

HHS has said it intends to engage in formal rulemaking to further clarify its guidance on EHBs but has not announced a timeframe when advocates can expect to see a regulation issued. For additional information on the December bulletin and its impact on behavioral health, see our Essential Health Benefits FAQ.

Many behavioral health organizations across the country are beginning to access federal incentive payments for the meaningful use of health information technology, including several National Council members. Yet, it is important to note that current law does not permit behavioral health organizations to request and access the incentives directly. Instead, the organization can only receive incentives through its “Eligible Professionals” on staff.

The National Council has created a new step-by-step guide to assist behavioral health organizations in accessing these incentive payments. The guide covers basic information about determining how many eligible professionals your organization has on staff, how they can reassign their incentive payments to your organization, advice on executing staff agreements, and more. It also includes links to helpful resources on the Centers for Medicare and Medicaid Services EHR Incentive Program website.

For additional information and resources on health IT and meaningful use, visit the Health Information Technology page of our website.

According to new guidance from the Centers for Medicare and Medicaid Services, Medicaid Recovery Audit Contractors will not replace existing Medicaid program integrity contractors under the terms of a final rule issued in September 2011. The recently released Frequently Asked Questions document also provides a refresher on the Recovery Audit Contractors (RAC) program.

The RAC model was created for Medicare in 2003; it was then expanded to Medicaid under Section 6411(a) of the Affordable Care Act. The ACA requires each state to establish a Medicaid RAC program so as to enable the auditing of claims for services furnished by Medicaid providers. These Medicaid RACs must identify overpayments and underpayments and must coordinate their recovery audit efforts with other contractors or entities performing similar work. The Medicaid RAC requirements became effective January 1, 2012, except for states that were granted an exemption by CMS.

CMS’ new FAQ offers advice on how states can prepare Medicaid providers for upcoming RAC audits. It suggests that states should provide:

• The name and contact information of the RAC selected by the state;
• A timeframe for when the RAC will begin identifying overpayments and underpayments; and
• General information on the RAC program.

The FAQ notes that states may exclude Medicaid managed care claims from review by the Medicaid RACs.

What is cost sharing and how will it change under health reform? What are health insurance exchanges and how will they affect me? How will the new law close the coverage gap for people on the Medicare, Part D program? The Robert Wood Johnson Foundation recently created a series of educational videos designed to answer your questions about 5 common terms that are often heard in connection to healthcare reform.

This week, the 26 states who have joined in a Supreme Court challenge to the Affordable Care Act filed a brief outlining their argument that the law’s 2014 Medicaid expansion is an unconstitutional infringement on state power. The states argue that through the Medicaid expansion, the federal government is essentially coercing them into covering new people by threatening to withhold federal Medicaid funds unless they do so.

Many legal experts agree that because states’ participation in Medicaid is voluntary, it does not constitute “coercion” for the federal government to attach requirements about how the funding is used. However, the states argue that participation in Medicaid “[is] not truly voluntary… While some individuals are exempt from the penalties designed to enforce the [ACA’s individual] mandate, no State is exempt from the massive penalty — the loss of the entirety of funding under the single largest grant-in-aid programs for the States — and so Congress did not even contemplate the possibility of a State opting out of Medicaid.”

The Obama Administration will have until February 10 to reply with a brief of its own in preparation for the oral arguments slated to be held in March. The states and the Administration have already submitted briefs outlining their arguments on the constitutionality of the individual mandate and whether the law can stand if the mandate is struck down.

Meanwhile, nearly 500 state legislators (at least one legislator from every state, including the 26 states that are signed on to the challenge) will file a brief with the Supreme Court today in support of the law’s mandate that all individuals have health insurance. The legislators argue that “the [Commerce clause of the Constitution] does not limit ‘commerce’ to existing economic activity or trade, nor does the text’s use of ‘regulate’ imply a power to prohibit but not require certain conduct.” The full summary of the legislators’ arguments is available here.

The Department of Health and Human Services has awarded more than $296 million to states for ensuring more children have health coverage. The performance bonus payments are funded under the Children’s Health Insurance Program Reauthorization Act, signed into law by President Obama in 2009.  To qualify for these bonus payments, states must surpass a specified Medicaid enrollment target. They also must adopt procedures that improve access to Medicaid and the Children’s Health Insurance Program (CHIP), making it easier for eligible children to enroll and retain coverage.

The bonuses came one week after new data from the Centers for Disease Control and Prevention showed that the number of children with insurance increased by 1.2 million since the 2009 CHIP reauthorization. An HHS issue brief notes that this increase has been entirely due to greater enrollment in public programs such as Medicaid and CHIP. (http://aspe.hhs.gov/health/reports/2011/CHIPRA/ib.shtml)

Performance bonuses help offset the costs states incur when they enroll lower income children in Medicaid.  By ensuring that states streamline their enrollment and renewal procedures, the bonuses also give states the incentive to adopt long-term improvements in their children’s health insurance programs. The 23 states eligible for performance bonuses include:  Alabama, Alaska, Colorado, Connecticut, Georgia, Idaho, Illinois, Iowa, Kansas, Louisiana, Maryland, Michigan, Montana, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, South Carolina, Virginia, Washington, and Wisconsin. Additional information is available online. http://www.insurekidsnow.gov/professionals/eligibility/performance_bonuses.html

The Center for Consumer Information & Insurance Oversight (CCIIO) at the Department of Health and Human Services has issued answers to Frequently Asked Questions about the implementation of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act. The FAQs address such topics as:

• After the amendments made by the Affordable Care Act, are small employers still exempt from parity requirements?
• Am I entitled to receive a copy of the criteria for medical necessity determinations made by the patient’s plan or health insurance coverage?
• I think my plan is applying medical necessity standards more strictly to benefits for mental health and substance use disorder treatment than for medical/surgical benefits. How can I obtain information on the medical necessity criteria used for medical/surgical benefits?

The parity FAQs are part of a series addressing many important aspects of the health reform law. Click here to visit CCIIO’s website and view the other FAQs.

In a recent article, Kaiser Health News (KHN) reported on how healthcare reform and its benefits are already well underway and exceeding expectations. An estimated 2.5 million young adults have already gained health insurance coverage since the health law took effect in 2010 – a number far higher than many predicted. The article discusses a variety of data and results which reflects the large number of young adults who have gained coverage.

According to KHN:

Officials based their number on U.S. Census data and the results of the latest National Health Interview Survey. In September 2010, the survey found 64.4 percent of adults between 19 and 25 were insured. By March, the rate was up to 69.6 percent, and in June it was at 72.7 percent. That month, the uninsured rate for this population reached its lowest point in more than a decade, down to 28.8 percent.

Click here to read the full article and to learn more about the new laws benefits on young adults.

1. Medicare Physician Pay Fix: In the last hours of its 2011 session, Congress enacted a short-term deal that postponed for two months a scheduled 27% reduction to Medicare physician payments. The cut was required under the Sustainable Growth Rate (SGR) formula, which compels Medicare to adjust payment rates each year to align with a predetermined rate of growth in the program. In practice, this has meant that Medicare payments would take an ever-increasing yearly cut – but each year, Congress has passed legislation postponing those cuts.

The newest 2-month “SGR fix” gives Congress until February 28 to reach a longer-term agreement to stave off the cuts. However, the same issues that plagued the December deal will continue to dog negotiators as they seek a permanent solution, with the biggest stumbling block being the question of how to pay for a long-term fix. Fiscal hawks in Congress have insisted on offsetting all costs with spending cuts elsewhere in the budget, but other legislators disagree on whether or where to seek savings. With the 2012 elections putting additional political pressure on an already divided Congress, it is unclear whether the two-month delay will be sufficient time for lawmakers to work out the details of a permanent fix – or whether they will enact another short-term patch.

2. The 2013 Budget and Congressional Efforts to Roll Back Sequestration: In another piece of 11^th-hour dealmaking, Congress reached an agreement on the 2012 budget shortly before a Dec. 16 deadline – and nearly three months after the start of the 2012 fiscal year. But lawmakers have only a short respite, as the 2013 budget battle is set to begin in early February with the President’s annual release of his budget requests. For the last two fiscal years, Congress has been unable to pass the 12 annual appropriations bills in time for the fiscal year to start, meaning that the government has been funded on a series of continuing resolutions – with frequent threats of a shutdown – until lawmakers have reached a budget deal. Despite lawmakers’ growing fatigue over the constant budget battles they have experienced since the start of 2011, intransigence on the part of the most hardline legislators may once again hinder a budget deal in 2013.

Meanwhile, this year’s budget battle is complicated by the failure of the Joint Select Committee on Deficit Reduction to agree on a plan for cutting $1.2 trillion from the budget. The “Supercommittee’s” failure means that automatic, across-the-board spending cuts (also known as sequestration) will go into effect on January 1, 2013. These automatic cuts are unpalatable for many lawmakers, and Congress will likely spend much of 2012 debating whether and how to roll back the cuts. Medicaid could be at risk in this process: during the Supercommittee negotiations, several plans were put forward that would have stripped hundreds of billions of dollars from the program by converting it to a block grant or making other drastic changes. Medicaid will remain a prime target for cuts as Congress considers the possibility of finding alternative budget savings that might prevent the need for sequestration. Our in-depth analysis of the aftermath of the Supercommittee’s failure is available on our blog.

3. Supreme Court Oral Arguments (and Decision) on the Health Reform Law: In November, the Supreme Court announced that it would take up the various legal challenges that have been mounted against the Affordable Care Act since its passage in March of 2010. Three major issues are at stake: whether the individual mandate that people have health insurance is constitutional; whether the rest of the law can stand if the mandate is struck down; and whether the Medicaid expansion is an unconstitutional infringement on states’ rights. Oral arguments are currently scheduled for March 2012, and a decision will be issued later in the year. Policy analysts are watching closely to see how the decision will affect the role that health reform plays in the 2012 elections – and how it will impact the rollout of reform. Click here for a more detailed analysis of what’s at stake.

4. HHS Regulation on Essential Health Benefits: A recently published informational bulletin from the Department of Health and Human Services (HHS) outlined how the agency intends to approach its task of determining what health insurance benefits will be deemed “essential” under the Affordable Care Act. The ACA requires insurance products and Medicaid benchmark plans for the newly eligible to cover at least the minimum essential benefits package – but the law only broadly identified what these benefits are, leaving the details to be determined by HHS.

Many advocates were hoping that the agency would require a broad range of covered services, but the recent information bulletin indicates that HHS will leave states with a great deal of discretion in identifying essential benefits for their own state. Of critical importance for the behavioral health field, the bulletin recognized the importance of including mental health and addictions treatment services at parity with medical/surgical benefits. However, it did not specify how HHS intends to apply the parity law, nor how it would ensure that states are adequately including MH/SUD services in their essential benefits. These details will likely be included in future rulemaking from the agency, and could have a major impact on the adequacy of coverage available to newly eligible individuals in 2014. Read our FAQ on Essential Health Benefits here.

5. Rollout of Medicaid Health Homes and Medicare Accountable Care Organizations: 2011 saw the launch of two major initiatives around integrated service delivery and coordinated care: the Medicaid Health Homes State Option and the Medicare Shared Savings Program (which creates Accountable Care Organizations within Medicare). Congress and the federal agencies will be closely monitoring the outcomes of these initiatives to get a gage on how integrated care activities may lead to improved outcomes and lower costs. Currently, two states have initiated the Medicaid Health Homes option for individuals with mental illness, and many others are engaged in talks with SAMHSA and HHS. The National Council will continue to follow the rollout of health homes across the country and will provide updates, success stories, and resources on our blog.

Meanwhile, the Medicare Shared Savings Program for the first time provides a system of federal support for an integrated care model that incentivizes coordinated care by the comprehensive range of providers involved in patient care. The nation’s fledgling ACOs are exploring several models for incorporating behavioral healthcare – from partnering with community behavioral health agencies to creating their own behavioral health capacity in-house. Mental health and addictions treatment organizations in communities where ACOs are forming should be working to be at the table during these discussions. The National Council has created several resources to assist, including our fact sheets “A How To Guide: Partnering with Health Homes and ACOs” and “Accountable Care Organizations: The Tipping Point for Behavioral Health.” Additional information is also available on our blog.