States That Don’t Expand Medicaid Leave Millions of Mentally Ill Uninsured: Report

“About 3.7 million Americans, who live in states that have not expanded their Medicaid programs under the Affordable Care Act, suffer from mental illness, psychological distress or a substance use disorder and don’t have health insurance, according to a recent report.

Twenty-four states have not expanded their Medicaid programs, according to USA Today. In the states that did expand Medicaid, about 3 million people with a mental health or substance use disorder, who were formerly uninsured, now are eligible for coverage. The findings come from the American Mental Health Counselors Association (AMHCA).”

Source: – April 9, 2014

How Obamacare May Lower the Prison Population More Than Any Reform in a Generation

healthcare reform 2“While many have focused on the individual mandate, and the online (and glitchy) insurance exchanges, one of the most potentially impactful elements of the Patient Protection and Affordable Care Act (ACA) has flown more or less under the radar. It may be the biggest piece of prison reform the U.S. will see in this generation.

The Justice Department estimates suggest that with the expansion of Medicaid, 5.4 million ex-offenders currently on parole or probation could get the health care they need. (It’s important to note that 25 states plus Washington, D.C. have implemented the Medicaid expansion as of 2014. However, many policy experts expect the remaining states to fall in line, citing the historical example of how CHIP was initially rejected by many states when it rolled out in 1997, but is now utilized in every state in the country.)

Even with coverage, those ex-offenders will still need to actually utilize those health benefits, and the key will be making the connection at the time of release. The biggest challenge will be getting state justice systems and health systems – not exactly happy bedfellows in past years – to work together to create coordinated discharge planning between jails and community healthcare.”

See related article from the George Washington University Milken School of Public Health –  Affordable Care Act Brings Crucial Health Coverage to Jail Population available at:

See related article from the Fix – Obamacare Rolls Out, Transforming Addiction Coverage available at:

Source: – March 10, 2014

U.S. Attorney General Holder Urges Use of Drug to Help In Heroin ODs

Attorney General Eric Holder declaring heroin addiction is an “urgent and growing public health crisis,” urged first responders to carry the drug naloxone that helps resuscitate victims from an overdose.

“Addiction to heroin and other opiates — including certain prescription pain-killers — is impacting the lives of Americans in every state, in every region, and from every background and walk of life — and all too often, with deadly results,” Holder said in a video message posted Monday on the Justice Department website.”

Source: – March 10, 2014

New York Attorney General A.G. Schneiderman Announces Settlement with Health Insurer That Wrongly Denied Mental Health Benefits to Thousands Of New Yorkers

“After an investigation uncovered widespread violations of mental health parity laws, Attorney General Eric T. Schneiderman today announced a settlement with Schenectady-based MVP Health Care, requiring the health insurer to reform its behavioral health claims review process, cover residential treatment and charge the lower primary care co-payment for outpatient visits to most mental health and substance abuse treatment providers. The settlement, the second against a health insurer so far this year enforcing the parity laws, also requires the health insurance plan — which has more than 500,000 members in the Albany region, Central New York and the Hudson Valley — to submit previously denied mental health and substance abuse treatment claims for independent review, which could result in more than $6 million being returned to its members.”

Source:  Attorney General Eric. T. Schneiderman – March 20, 2014

Winter 2014 Issue of SAMHSA News Now Available Online

Articles of interest on parity and the Affordable Care Act include:

  •  Final Parity Rule Issued – Learn what the final rule on the Federal Parity Law means for insurance coverage of behavioral health services.
  • Affordable Care Act Update – Q&As on the Health Insurance Marketplace and the latest on efforts to enroll consumers.

Source: Substance Abuse and Mental Health Services Administration – February 3, 2014

Interview: Zac Talbott on Being a Patient and Certified Advocate for Medication-Assisted Treatment

Zac 2-9-14Patients and other individuals who are advocates are a growing force in medication-assisted treatment (MAT) for opioid dependence, providing information and support to patients as well as assistance to opioid treatment programs (OTPs). Advocates also are an essential link between patients and OTPs. They are not as well known as they should be, there aren’t enough of them, and they are in dire need of funding.

In January, Zac Talbott, a patient who is the director of the Tennessee Statewide and Northwestern Georgia chapter of the National Alliance for Medication Assisted Recovery (NAMA Recovery), shared his experiences with addiction, treatment, recovery, and patient advocacy with AT Forum.

 Getting Started in Advocacy: The CMA

Patients and others who want to be advocates need to first have a good knowledge of advocacy and the various issues surrounding MAT. Taking the CMA (Certified Medication Assisted Treatment Advocate) course and obtaining certification gives both patients and health care professionals the basic grounding for advocacy. Certification is essential to being a credible advocate. “There are patients out there who often are well-meaning, who claim to be advocates, but who can do harm,” he said. “A lot of folks without training do not realize that advocates have a code of ethics, and one of the main ethical guidelines is confidentiality. It goes to the heart of our professional credibility. There has never once been a case of a patient’s confidentiality being violated by a CMA working with NAMA-R.”

The second crucial skill that CMAs have is knowing how to communicate with OTPs on behalf of a patient. “You can make things worse for the patient you’re trying to help if you come off like an attack dog. Patients and OTPs agree on more than 90 percent of the issues, and that should always remain the primary focus. It’s also important to remember that the job of a patient advocate is to advocate for what the patient wants. We can’t take off and start a crusade without that patient wanting us to,” he said.

NAMA-R developed the CMA training course with no funding, which was a tremendous challenge. However, the course has been strongly supported by the American Association for the Treatment of Opioid Dependence (AATOD), and the federal Center for Substance Abuse Treatment (CSAT).

 Volunteering and Funding

Some NAMA-R chapters could do significantly more if their expenses were paid. Members are committed people who largely volunteer their time and give of themselves without any compensation.

NAMA Recovery chapters do need funding. NAMA-R is a 501c3 non-profit organization, so donations are tax-deductible. All other industrialized countries fund organizations like NAMA-R, said Mr. Talbott. “The United States is the exception. This leaves NAMA-R dependent on donations from patients, for-profit OTPs, and the pharmaceutical industry.”

In Tennessee—and in many other states—Medicaid won’t currently pay for MAT with methadone. “It’s all cash down here,” he said. The fee for patients is $300 to $400 a month—frequently all the money a patient has.

Mr. Talbott hopes NAMA Recovery can partner with OTPs for funding and support. “We had a wonderful meeting with Chief Operating Officer Jerry Rhodes and the regional managers of CRC Health Group during the AATOD Conference in Philadelphia this past November,” he said. “They recognize that advocacy is extremely important.”

 Insurance and the ACA

Whether the Affordable Care Act (ACA) will help fund MAT is still unclear, said Mr. Talbott. “It’s supposed to, but insurance companies are good at finding loopholes.” Implementation and enforcement are still problematic.

In Tennessee, for example, the state is making it impossible for new OTPs to open, which means that facilities are opening up across the state border. “Programs in other states are treating the patients that Tennessee isn’t,” said Mr. Talbott. If Tennessee Medicaid were to say that patients had to be treated in a Tennessee facility, that might make it more attractive for programs to open in Tennessee.

Even though his organization is in Tennessee, most of Mr. Talbott’s calls come from outside the state—just because there are so many patients, especially in nearby southern states, who need help. NAMA-R has always had difficulty recruiting individuals willing to make a commitment to advocacy and start a chapter. Stigma, prejudice, and just plain fear have been barriers in southeastern states.

 From Pain Medication to Heroin

Mr. Talbott’s addiction started—as with many people—with a prescription for hydrocodone for a chronic painful condition. Most people feel sick when they take opioids, but Mr. Talbott is part of the 10 percent of the population that is susceptible to addiction. “I loved them,” he said of opioids. His addiction sent him to buying pills from a pill mill and eventually to the street, where he also bought heroin. “This was in the late 90s,” he recalled. “Within eight years I went from a couple of prescribed hydrocodone a day to 25 prescribed 30-milligram doses of oxycodone.” He became an intravenous drug user within four years of initially starting the pills.

“The opposite of the stereotypical drug user,” Mr. Talbott had two college degrees when he first became addicted to opioids, and came from a well-known and well-respected family—“church folks,” he explained.


Then, there was treatment. “I went for all the wrong reasons—I didn’t go because I was seeking recovery,” Mr. Talbott said of his treatment in an OTP. “People who are drug users think that there’s no withdrawal, and that you might even get a little buzz.” But six months after entering the OTP and starting methadone, he found that he was in recovery—by accident. “I had no craving. I stopped using the needle. I was thinking about my life again—by accident. The person I was prior to the addiction quickly started to re-emerge. That’s the beauty of methadone.”

After that, it took Mr. Talbott a year to focus on recovery and life. “There’s so much you need to do, straightening out your credit, fixing everything you did when that disease is active.” When his addiction was at its height, he was in the middle of his masters’ in clinical social work. Ultimately, the addiction took over and he left the program. But even before his addiction, he had always wanted to be in a helping profession—a mental health counselor, an Episcopal priest, or a lawyer. “I wanted to help people,” he said. “Once I was in recovery, that part of me came back quickly.”

He found NAMA Recovery because his counselor recommended it as an alternative to driving to the clinic for four group meetings during his induction period in treatment. “I had to drive more than two hours one way to the OTP because I was so rural. So my counselor said to go to the website——print out, read, and bring in one of the Education Series to discuss ‘and that will count as one of your groups.’” Ultimately, he wrote to the NAMA-R chapter coordinator and said a NAMA Recovery chapter was needed in Tennessee.

NAMA Recovery’s main goal is advocacy, and that is where Mr.Talbott saw his life heading. “It’s a natural fit,” he said. “To be a MAT advocate is to advocate for the patient in treatment, but we’re not patient advocates only or specifically. ‘The patient comes first,’ as Rokki [Roxanne Baker, NAMA-R president] often says.”

 Partnership With OTPs

Patient advocates can have a lot of power, not only on behalf of patients, but on behalf of providers. When onerous restrictions are imposed by states, especially states that don’t have an AATOD chapter, providers call NAMA Recovery. “We are more than just patient advocates, we are MAT advocates,” said Mr. Talbott. “We advocate for the entire modality.”

About a third of the calls he gets—Tennessee joined AATOD just last fall—are from OTPs, said Mr. Talbott. “Sometimes patients and providers don’t have the best relationship. Some OTPs view advocates as whistleblowers and troublemakers, and sometimes the OTPs get defensive as soon as advocates call them. Several of us are trying to stress to OTPs and patients that we’re all on the same team.”

Technically, the provider advocacy organization is AATOD. But when there is an issue that draws both patient and provider complaints, Mr. Talbott reaches out to consult with AATOD president Mark Parrino or the state chapter of AATOD. “We can strategize together,” he said. Sometimes the approach involves filing a complaint with the Department of Justice or SAMHSA’s CSAT, which regulates OTPs. Often, OTPs haven’t even heard of NAMA Recovery, and sometimes haven’t heard of AATOD either, he said.

“The way to go is moving away from patient advocacy specifically and toward MAT advocacy as a modality,” said Mr. Talbott. And patients who are certified advocates can be of immense help to OTPs, whether they are testifying before the legislature or making a complaint to the Department of Justice. Patients and providers aren’t always going to agree, but ultimately they’re fighting the same battles and striving for the same goals.

Blog: What Health Care Reform Could Mean for Drug Policy and Mass Incarceration

healthcare reform 2“What does the Affordable Care Act (ACA) mean for drug policy?. A new issue brief – From Handcuffs to Healthcare — published by the Drug Policy Alliance (DPA) and the American Civil Liberties Union(ACLU) outlines how the ACA could help our country end the war on drugs and move toward a health-based approach to drug policy

This paper is intended as a starting framework for criminal justice and drug policy advocates to navigate the ACA, and to take advantage of the conceptual and practical opportunities it offers shifting the conversation and the landscape.

Part One of this paper describes some of the major provisions of the ACA relevant to our work: the health insurance requirement; the places many people will buy insurance, called health exchanges; Medicaid expansion; insurance coverage requirements for substance use and mental health disorders; and opportunities for improved models of coordinated care.

Part Two of this paper outlines a series of practical recommendations, including program and policy examples and suggested action steps, across three broad categories:

  • Ensuring access to care for people most likely to be steered into the criminal justice system under the current framework
  • Leveraging the ACA to reduce incarceration and criminal justice involvement
  •  Moving from a criminalization-based drug policy approach to one rooted in health

The Brief can be accessed at:

Source: - December 3, 2013 and – December 2013

New from the Legal Action Center – FAQs on Recently Released Federal Parity Regulations

parityIn November the Legal Action Center issued Frequently Asked Questions on the final Federal Parity Regulations. Questions answered include:

  • What is the federal parity law?
  • How does the federal parity law work?
  • Which programs must comply with the federal parity law?
  • When does the final parity rule go into effect?
  • What are the major areas the final parity rule addresses?
  • How does the final parity rule address scope of service?
  • Does the final parity rule discuss residential treatment?
  • Does the final parity rule give additional guidance on the application of the parity law to non-quantitative treatment limitations (NQTLs)?
  • Does the final parity rule give additional examples of NQTLs?
  • How does the final parity rule address provider rates?
  • Under the final parity rule, what are plans required to disclose to consumers?
  • Who has primary monitoring and enforcement oversight over the parity law?
  • How does the final parity rule address the relationship between the federal parity law and state laws?
  • Which types of plans must comply with the final parity regulations?
  • What guidance governs other types of coverage that has to comply with the federal parity law?

The document also provides links to regulations and other forms of guidance the government has issued on the federal parity law. The document is available at:

Source: Legal Action Center – November 2013

HHS Announces Affordable Care Act Mental Health Services Funding

fundingThe U.S. Department of Health and Human Services (HHS) announced December 10 that it plans to issue a $50 million funding opportunity announcement to help Community Health Centers establish or expand behavioral health services for people living with mental illness, and drug and alcohol problems.  Community Health Centers will be able to use these new funds, made available through the Affordable Care Act, for efforts such as hiring new mental health and substance use disorder professionals, adding mental health and substance use disorder services, and employing team-based models of care.

“Most behavioral health conditions are treatable, yet too many Americans are not able to get needed treatment,” said Health Resources and Services Administration (HRSA) Administrator Mary K. Wakefield, Ph.D., R.N.  “These new Affordable Care Act funds will expand the capacity of our network of community health centers to respond to the mental health needs in their communities.”

“These new funds will further the Department’s work to develop integrated primary and behavioral health care services to better meet the needs of people with mental health and substance use conditions,” said Substance Abuse and Mental Health Services Administration Administrator, Pamela S. Hyde.

It is estimated these awards will support behavioral health expansion in approximately 200 existing health centers nationwide.

Source: U.S. Department of Health and Human Services – December 10, 2013

Final Parity Rule Issued

Scales of JusticeOn Friday, November 8, the Departments of Health and Human Services, Labor and the Treasury issued the final rule to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.

The final rule includes specific additional consumer protections, such as:

  • Ensuring that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings;
  • Clarifying the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law;
  • Clarifying that parity applies to all plan standards, including geographic limits, facility-type limits and network adequacy; and
  • Eliminating an exception to the existing parity rule that was determined to be confusing, unnecessary and open to abuse.

The Substance Abuse Mental Health Services Administration (SAMHSA) has developed a web page that provides links to related resources including links to the final rule, fact sheets, a SAMHSA webinar on parity, and links to frequently asked questions.

See related article on parity from Behavioral Healthcare: Strong final rule for parity means big strides for residential, out-of-state treatment available at:

Source: The Substance Abuse Mental Health Services Administration – November 8, 2013

OTPs as Health Homes: Extra Money for Care Management

healthcare collageSome states are making opioid treatment programs (OTPs) health homes under a federal strategy that is part of the Affordable Care Act (ACA). Under the initiative, which comes from the Centers for Medicare and Medicaid Services (CMS), states can pay OTPs extra money to serve as “health homes” for their patients, meaning that the OTPs will help clients manage both their physical and behavioral health needs, including chronic conditions like obesity and diabetes.

So far, only Maryland, Rhode Island, and Vermont are paying OTPs to be health homes under the ACA. AT Forum talked with health home leaders in the first two states.

“This is a CMS strategy and an endeavor that we support,” said H. Westley Clark, MD, JD, director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA). “From our point of view, we believe the ACA is an important vehicle for behavioral health, and that includes OTPs.”

For OTPs to play an enhanced role under the ACA, states need to apply for approval from CMS to allow the OTPs to serve as health homes, and must use Medicaid money for this purpose.

“The states that have included OTPs in the state plan amendments are doing the field a favor,” said Dr. Clark. He added that this is a critical step, as OTPs try to become participants in the new reimbursement framework.

The state Medicaid dollars that will be going to OTP health homes will initially be matched 90 percent by the federal government.

The logic of selecting OTPs to be health homes, among all substance abuse treatment providers, is that OTPs already have medical staff. OTP patients have a range of conditions that medical staff can address, Dr. Clark said.

SAMHSA has strongly promoted the need for OTPs to have electronic health records, qualified service organization agreements, and health homes, “so OTPs can play a stronger role” under the ACA. CMS is the lead agency on the ACA, with SAMHSA on the periphery, Dr. Clark explained. “Since this is a nascent activity, our role has not been robust. But we are talking to the American Association for the Treatment of Opioid Dependence (AATOD) and to OTPs about the ACA and our hope that OTPs will play a larger role in the delivery of services.”

There’s a big difference between a “patient-centered medical home,” which is a very broad term, and a “health home,” which is codified in the ACA. A health home is for individuals with a chronic condition; importantly, a substance use disorder (SUD) is included in the definition of a chronic condition. A patient-centered medical home is a primary care approach in which there is a home base for both healthy and unhealthy people.

 To participate in a behavioral health care health home under the ACA, and to qualify for the 90-percent federal match, the patient must either have a serious and persistent mental illness and two chronic conditions, or have one chronic condition and be at risk for another. In other words, patients with an SUD and at risk for another chronic condition would be eligible, and this constitutes almost all patients in OTPs.

Rhode Island

Rhode Island was still waiting to hear back from CMS on its state plan amendment, which created health homes in OTPs, when AT Forum interviewed Rebecca L. Boss, administrator of behavioral health services in the state’s Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals. But because the CMS decision can be retroactive—and approval of the proposal was expected—the state is going ahead with implementing health homes at five of the state’s six OTPs.

Ms. Boss, who is also the State Opioid Treatment Authority (SOTA) for Rhode Island, said having OTPs be health homes is a “passion” for her. “Having worked in an OTP, I know first-hand that patients in opioid treatment who have chronic conditions have had difficulty accessing quality medical care,” she told AT Forum. “What better place, in my mind, than an OTP where patients have relationships with medical staff, where they’re comfortable, and where they show up on a regular basis.”

Barriers to health care for OTP patients have included stigma, transportation problems, and lack of insurance, noted Ms. Boss, who added that some patients just need help following up on treatment plans, such as taking medication for diabetes.

A small state, Rhode Island has 3,800 OTP patients receiving methadone maintenance treatment on any given day. About 2,000 are current Medicaid clients—a number that will grow on January 1 when Medicaid expands.

$87 per Patient per Week

There will be 125 patients in each OTP “health home” team, with at least 10 teams statewide, Ms. Boss said. OTPs will get about $87 per week for each patient in a health home team. This rate is separate and apart from what OTPs receive for treatment and an important part of rate setting was teasing out which services covered under treatment would be considered health home activities. Ms. Boss added that the federal government pays 90 percent of the health home service part for the first two years.

Factors such as tobacco use, obesity, and increased age can count as risk for development of a second chronic condition, in addition to SUDs, according to Ms. Boss. “It would be rare that clients in an OTP not meet the criteria” for being in a health home.

One of the biggest challenges will be recruiting patients for health homes. Enrollment has to be voluntary. In Rhode Island, individuals have been auto-enrolled, but have the right to opt out, Ms. Boss explained.

Something New?

OTPs don’t need to provide health care services to be health homes, but they do need to make sure patients have access to such services. In Rhode Island, there will be a nurse dedicated to following 125 patients, coordinating their care. “Patients don’t have to go to just any nurse at a dosing window, they have their own nurse who will help them,” said Ms. Boss.

In many cases, OTPs have already been helping patients who have health issues. “This is the opportunity to reimburse them for some services they have been doing all along,” according to Ms. Boss. “They haven’t had a lot of case managers, but counselors have been doing yeoman’s work in terms of case management.” She added that the health home fees will also pay for part of a physician’s time, the services of case managers, the coordinating services of a masters-level team, and a pharmacist to coordinate medications.


Maryland has identified three provider types to be health homes—two are mental health, and one is an OTP. To be eligible as a health home, an OTP must be enrolled with Maryland Medicaid, be accredited by CARF International or the Joint Commission (or pursuing such accreditation), and submit an application to the state. As of November 4, eight OTPs have submitted applications and three have been approved.

According to Lisa Hadley, MD, clinical director of the state’s Alcohol and Drug Abuse Administration and Mental Hygiene Administration, participants must have an SUD, be in methadone treatment, and be at risk for another chronic condition—similar to the Rhode Island health home initiative. For the three OTPs approved so far, there are almost 1,000 patients—410 in one OTP, 281 in another, and 285 in the third.

Almost $99 per Patient per Month

Maryland health home OTPs will be paid an additional $98.87 a month for each patient in the health home, said Dr. Hadley, who is also the SOTA for Maryland. The OTPs will be responsible for providing six different services: comprehensive care management, care coordination, health promotion, individual and family support, and referrals for community support. “Through all their treatment, whether they’re in the hospital or in the community, the health home is responsible for helping to link the patient to what they need.” According to Dr. Hadley, Maryland Medicaid will pay the additional fee, with the federal government paying 90 percent for the first two years, after which the match goes down to the standard 50 percent.

The state will also help the OTPs by providing data on hospital encounters and pharmacy alerts, she said. The program started in October, and is expected to grow in January. “We hope to be getting more applications” from OTPs. “We’re very excited to be able to help OTP patients.”

In California, a Focus on Getting OTP Patients Enrolled in Medicaid

MediCalOpioid treatment programs (OTPs) have many patients—childless adults, mainly men—who have not been eligible for Medicaid. They are self-paying for their treatment. In these weeks before the Affordable Care Act (ACA) takes effect and self-paying patients can be covered under its Medicaid expansion provision, some OTPs are working feverishly to make sure that these patients are enrolled, and finally freed from the burden of paying out of pocket—something that will improve the chances that they will stay in treatment.

At Bay Area Addiction Research and Treatment (BAART), the focus is on implementing Medicaid expansion, said president Jason Kletter, PhD. BAART is based in California and has expanded into Arizona, North Carolina, Nebraska, and Vermont, serving more than 6,500 patients a day. BAART also provides primary medical care and mental health services through fixed sites and mobile vans.

“My organization has been certified as an enrollment entity, and we have about 30 people at sites around the state ready to enroll patients,” Dr. Kletter said. There have been logistical problems, but “we’ll get there eventually.” As in the rest of the country, technical hiccups in getting started are expected to be worked out well in advance of the January 1 ACA implementation date. “We currently have certified enrollment counselors who can’t do their job yet,” he said. The state’s exchange, Covered California, is managing the enrollment.

Dr. Kletter thinks the main advantage of Medicaid expansion will be to make sure current patients who are paying their own way will have insurance. “It’s a great benefit for these patients, because these are the folks who have a hard time staying in treatment.”

California Medicaid, called Medi-Cal, is still fee-for-service for treatment of substance use disorders (SUDs); many states are applying for federal waivers to put this population and health care providers under managed care. Instead, California went through a “realignment,” in which SUD treatment went from a centralized state management system to payment by the counties. “And they’ve added a lot of benefits to the Medicaid benefit, said Dr. Kletter—residential, intensive outpatient, and other services.

Medicaid money goes through the counties, and OTPs contract with each county, said Dr. Kletter. “After the realignment, I don’t see this being managed” by private insurance companies, he added.

But what about patients who already have commercial insurance—they have traditionally found it impossible to use their insurance to get reimbursed for treatment in an OTP, and they also had to pay out of pocket. That may be changing soon. “There’s been a recent change of heart, and managed care organizations are starting to reach out to OTPs in California,” said Dr. Kletter. The OTPs met with the state last year about this. “We think that the exclusion is discriminatory,” he said, referring to insurance policies that specifically excluded treatment with methadone in an OTP, or any treatment in an OTP. Of course it is discriminatory, under the ACA and the parity law. Any change in this would be a “great development,” Dr. Kletter believes, expanding OTP access not only to many people covered by Medicaid but also to people covered by private insurance.

Article from SAMHSA News: Sign Up for Health Care Coverage

healthcare reform 2“Starting October 1, 2013, Americans who are uninsured or who buy their own health insurance coverage will have a new, hassle-free way to shop for insurance: the Health Insurance Marketplace. The site provides easy-to-understand information about all coverage options for consumers.

To prepare for the Marketplace’s opening, the Federal Government has revamped its website. (A Spanish version is available at The government has also launched a new consumer call center: 800-318-2596.

“The new website and toll-free number have a simple mission: to make sure every American who needs health coverage has the information they need to make choices that are right for themselves and their families—or their businesses,” said U.S. Health and Human Services Secretary Kathleen Sebelius.

The website has information about benefits and key deadlines, and describes how the new Marketplace will work. There are also new resources, videos, and checklists.”

The article can be accessed at:,+heatlh+care+coverage,+marketplace&utm_campaign=SAMHSA+News+Fall+2013+-+ACA+eBlast

Additional articles in the Fall 2013 issue of SAMHA News include:

  • Veterans Court Provides Treatment and Support
  • Survey Shows Continued Reduction of Prescription Drug Use among Young Adults
  • Community Conversations on Mental Health Seek Solutions
  • Behavioral Health Resources for Times of Disaster

Source: The Substance Abuse and Mental Health Services Administration SAMHSA News – Fall 2013

PPACA May Steer 40 Million to Drug, Alcohol Programs

“The closer the nation gets to the full implementation of the Patient Protection and Affordable Care Act, the bigger the numbers being tossed around become.

The other day it was 37 million — the number of people a Stanford Medical School study suggested might bolt their employer health plan for exchange coverage. Now, we hearing that 40 million folks may enter drug and/or alcohol rehab programs once the act takes effect.

Understandably, this could lead to a huge demand for new treatment services that are aligned with the guidelines and goals of the act.”

Source: – September 12, 2013

Affordable Care Act (ACA) Timeline: Key Dates for Providers and Patients

health_care_reformA slide show of key dates for the Affordable Care Act available from Medscape Business of Medicine.

You must be registered with Medscape to view this article. Register here.

Source: – August 23, 2013

Ohio: Medicaid’s Role in Drug-Abuse Treatment Debated

medicaid“Ohio’s growing heroin and prescription drug problem has collided with the biggest issue facing the state legislature this fall: whether to expand Medicaid health care benefits to hundreds of thousands of low-income residents.

The Medicaid debate is set to be the top issue the General Assembly tackles when it returns to Columbus next month. An Oct. 1 deadline is looming over supporters of Republican Gov. John Kasich’s proposal to take federal money to expand Medicaid under the health care reform law, the Patient Protection and Affordable Care Act. After Jan. 1, Ohio will begin to lose out on more than $13 billion promised by the federal government.”

Source: – August 28, 2013

Treatment for U.S. Opioid Addicts Often Inadequate, Researchers Say

In an article published in August in the journal Health Affairs, Dr. Bohdan Nosyk and seven other experts in the field say there’s a major gap between current treatment options and evidence-based practices.

“Forty-five years after the introduction of opioid substitution treatment, practitioners have at their disposal more tools than ever to treat opioid dependence,” the researchers wrote. “Yet these tools are not being used to their greatest potential in the United States or Canada.”

Nosyk — an associate professor of health economics in the Faculty of Health Sciences at Simon Fraser University in Burnaby, British Columbia — said excessive regulation presents the biggest barrier for treatment in the U.S.

He spoke to the PBS NewsHour recently about the current state of opioid addiction treatment, options for closing some of the existing gaps and how the Affordable Care Act might play a role.

Source: – August 5, 2013

More Women Could Receive Addiction Treatment Under Health Reform: Expert

health_care_reform“The number of women receiving treatment for substance use disorders could rise under changes that will be implemented as part of health care reform, according to an expert at UCLA.

“Christine Grella, PhD, Professor-in-Residence in the Department of Psychiatry & Biobehavioral Sciences at UCLA Integrated Substance Abuse Programs says some aspects of the Affordable Care Act are likely to make it easier for women to access care.

Women who seek substance use disorder treatment tend to have a more severe clinical profile, including more co-occurring disorders such as anxiety, depression and trauma. They also tend to have multiple problems such as lack of childcare and employment. But while women are less likely to seek addiction treatment, they are more likely than men to seek health services in general, Dr. Grella noted. They are also more likely to use mental health services.”

Source: – August 2, 2013

Treatment for Substance Use Disorder: Opportunities and Challenges under the Affordable Care Act

health_care_reformDrs. Nora Volkow and Betty Tai of the National Institute on Drug Abuse recently authored a paper envisioning systems changes under the Affordable Care Act and new models for addressing the continuum of substance use. The article concluded:

“Addiction is a chronic disease for which multiple episodes of treatment, remission, relapse, and retreatment frequently occur before achieving stable recovery. The recent health care reform legislation provides many opportunities to transform an episodic and reactive treatment model into a proactive chronic treatment care model. A comprehensive chronic care model (CCM) for substance use disorder (SUD) should start from routine screening and brief intervention (SBI) in primary care settings to detect early-risk behaviors in patients. The care for persons diagnosed with SUD should follow a CCM with effective coordination and collaboration between primary care and behavioral health care services to ensure continuity of care. Aggressively leveraging modern health information technologies (HITs) and expanding roles of nonphysician workforces, such as social workers, are critical to the success of chronic care management of SUD. With a new transformed care model, prevention and early treatment for SUDs will become an essential part of a more effective continuing care system, which under full implementation of the ACA will lead to vastly improved public health in the United States.”

 The article that appeared in a recent issue of the journal Social Work in Public Health is available at:


Source: Clinical Trials Network Dissemination Library – 2013

From the Publisher: The Story for OTPs This Summer: Health Care Reform

healthcare reform 2In the summer 2013 issue of AT Forum, one theme keeps coming up—and driving—the story for opioid treatment programs (OTPs). It is health care reform—the Affordable Care Act (ACA), which goes into full-implementation mode in January 2014. Patients are going to be signing up for Medicaid and commercial insurance, which will reimburse OTPs for services as early as October, when the exchanges open up. That’s right around the corner, and it’s a major change in the reimbursement landscape.

This issue’s interview with Elinore F. McCance–Katz, MD, the new medical director of the Substance Abuse and Mental Health Services Administration (SAMHSA), is a case in point. The federal government’s regulator of OTPs is talking about health homes. It’s a big challenge, but something that OTPs, with their comprehensive services, are ready for.

That takes us to the story on the SAMHSA draft guidelines for OTPs, which give unprecedented authority to physician assistants and nurse practitioners, making it much easier for programs to accommodate increased patient loads. In another set of guidelines, the City of Philadelphia—which is hosting the American Association for the Treatment of Opioid Dependence annual meeting this fall, where the SAMHSA guidelines are expected to be released—has funded a landmark recommendation for managing benzodiazepine use in OTPs. That story is detailed in a fascinating interview with Roland Lamb.

And on a state level, California is in the midst of a good-news, bad-news scenario—with the good news overwhelmingly outweighing the bad. California’s Medicaid program is expanding under the ACA, allowing many patients who were previously uncovered by insurance to have coverage. That means that instead of struggling to come up with the funds to pay for treatment in OTPs, these patients will be paid for by Medicaid. The bad news comes for patients on the exchanges, where people buy their own commercial insurance with subsidies: methadone maintenance in OTPs is not covered, but buprenorphine maintenance from a physician, with no required counseling, is. At the same time, OTPs in California, as elsewhere, continue to make the case for comprehensive services.


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