Saturday, July 22, 2017
Federal

RCPA is hosting a free educational webinar on the Federal ORP (order, refer, or prescribe) Requirements on Wednesday, August 16, 2017, 1:00 pm – 3:00 pm. The webinar will be presented by David C. McAdoo, MBA, Executive Director, Southwest Behavioral Health Management, Inc. and Jamie Buchenauer, Director, Bureau of Fee for Services. Registration is required. Please register here to participate.

The Affordable Care Act requires all physicians including psychiatrists, physician assistants, and certified registered nurse practitioners to directly enroll in PA State Medicaid (PROMISe) to order, refer, or prescribe medications, testing, services, or other items billed to Medicaid. Any MD acting as the Medical Director in a licensed substance abuse or mental health facility must meet this requirement for the facility to bill Medicaid. Specifically, each psychologist, MD, CRNP, or PA touching the PA State Medicaid program must have at least one PROMISE ID under the NPI number on their license.

This webinar will address the requirement, the specific services that are covered, documentation that must be collected, the modifications needed in claims to bill Medicaid moving forward, and strategies for maintaining patient safety and uninterrupted access to medication and services during the transition to full compliance with this new requirement.

Outline

  • Introductions
  • Overview of Goals
    1. Understand the purpose of the ORP
    2. Understand which medical licenses are covered under the ORP
    3. Understand which medications, labs, services, and other benefits are covered under the ORP
    4. Understand the impact of the ORP on Medicaid and Medicare access to:
      1. Medications
      2. Lab Testing
  • PH Testing
  1. Behavioral Health Services
    • BHR Services
    • Peer Support and Psych Rehab
    • Family Based
    • BH services with an identified “medical director”
  • Understand the technical requirements for paper and electronic claim submission compliance with the ORP
  • Identify the changes and/or modifications needed in BH services to document ORP compliance
  • Identify the actions that are needed to assure all clients have uninterrupted access to BH and all prescribed medications
  • Review the timelines for ORP implementation in PA

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This weekend, Senator McConnell announced that there would be no vote on the BCRA this week, and the Congressional Budget Office (CBO) announced that there would not be a score of the BCRA, either. Additionally, the State Senate is scheduled to return today in the midst of a possible state budget action. Because of this, Wednesday’s press conference is being postponed.  We will keep you updated on future events.

RCPA has been working with a multi-association group to oppose the federal proposed American Health Care Act (AHCA)/ Better Care Reconciliation Act (BCRA). We previously sent a letter to Senators Casey and Toomey and are now planning a letter to the editor and press conference. The effort has been led by the Hospital and Healthsystem Association of PA (HAP), but has been a very collaborative initiative, and RCPA will be speaking at the press conference along with several other associations. We encourage you to attend this event which is being held at the Capitol in Harrisburg on Wednesday, July 19 at 11:00 am. For additional information contact Jack Phillips, Director of Government Affairs.

nc-action-alert

The Senate has released its version of the American Health Care Act and it is worse than we feared. The Senate bill will cut Medicaid even more than the House bill in the future, putting tremendous pressure on safety-net services and providers.

But there is still time to act! The Senate is gearing up for a vote in the coming days, so NOW is the time to speak up and protect Medicaid.

unite-4-bhTaking action is easy:

  1. Dial this number: 202-224-3121
  2. Ask for your Senator.
  3. Share with them this message:
    • Your Message: I am calling to ask the Senator to vote NO on the Better Care Reconciliation Act. Cutting Medicaid and rolling back the Medicaid expansion will have a devastating effect on people with mental illnesses and addictions who rely on Medicaid for lifesaving treatment. Please vote NO. I’m calling from [city, state, and zip] and my name is [first and last name].
  4. Call your other Senator and share the same message!

Thank you to all who have taken action on this issue so far this year. We appreciate your hard work and dedication and ask that you continue to mobilize and advocate on this critical issue! Together, we can protect and preserve Medicaid for millions of Americans in need.


 

Questions, contact Jack Phillips.

Until today, it was hard to imagine a bill could be worse for Americans living with addiction and mental illness than the AHCA bill passed last month by the House of Representatives.

The Senate version of the American Health Care Act purports to be a “repeal and replace” of the Affordable Care Act, but is really a draconian restructuring and gutting of Medicaid, the program that covers 20% of Americans and is one of the primary payers of addiction and mental health treatment in the U.S.

Instead of “repeal and replace,” it is “wreck and wreak havoc.”

The bill’s supporters have said that their newest proposal would “soften the landing” for Americans who will lose Medicaid coverage. In reality, the landing would be catastrophic. There is nothing “soft” about ripping health care away from the 11 million Americans enrolled in the Medicaid expansion. The new bill also shifts hundreds of billions of dollars in costs to states—leaving them with a Sophie’s Choice of which populations and benefits to cut in order to close their budget shortfalls. Seniors? Pregnant woman? People with a preexisting condition, like cancer or a heart attack? Who do we help, and who do we turn our back on?

The Senate bill also slices and dices Medicaid enrollees into the deserving and the undeserving, exempting some populations with disabilities from the caps while leaving other vulnerable individuals—like people with addictions—out in the cold. Lawmakers must remember that people with addictions do not qualify as “disabled” under a Gingrich-era change that excluded them from Social Security Disability. The proposed cuts to Medicaid would disproportionately harm those who rely on Medicaid for lifesaving opioid addiction treatment, at a time when mortality from the opioid epidemic is growing at devastating speed each year. We are facing a national emergency on opioids – now is hardly the time to reduce our efforts.

The bill’s feeble attempts to bolster psychiatric treatment while stripping health care away from millions are paltry at best. While the outdated law prohibiting Medicaid funding for services provided in residential or inpatient treatment settings deserves to be changed, the small tweak to this payment exclusion that is included in the bill will do nothing to mitigate the loss of Medicaid coverage for millions—nor does it provide for important outpatient care serving people in their own communities. The proposed one-year grant fund for mental health and addiction treatment in 2018 doesn’t come close to meeting the real—and growing—need for care. Grants are not a substitute for health coverage. We don’t rely on grants for the treatment of heart disease or cancer, and addiction and mental health should be no different.

Congress has made incredible strides in advancing access to care for mental illness and addiction in recent years. It is shocking that members of Congress – many of whom have family members who would be affected and all of whom represent constituencies who would be gravely harmed – would even consider a bill that would obliterate these gains, returning us to the days when people with mental illness or addiction couldn’t access treatment.

This is not our vision for America. Slashing billions of Medicaid dollars from state budgets would cost hundreds of thousands of lives. The National Council urges the Senate to vote down this reprehensible bill.

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The National Council for Behavioral Health is the unifying voice of America’s community mental health and addictions treatment organizations. Together with 2,800 member organizations, it serves more than eight million adults and children living with mental illnesses and addiction disorders. The organization is committed to ensuring all Americans have access to comprehensive, high-quality care that affords every opportunity for recovery and full participation in community life. The National Council, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health pioneered Mental Health First Aid in the U.S. and has trained more than 1 million individuals to connect youth and adults in need to mental health and addictions care in their communities. To learn more about the National Council, visit the official website.

The following is from an ANCOR “Save Our Services” alert that was issued today:

“Earlier today, the Senate released its version of the American Health Care Act, now called the Better Care Reconciliation Act of 2017, 142 pages of proposed legislation that built off the House passed version from May. READ THE BILL HERE.

Our fears are now founded. Intelligence that ANCOR has gathered over the past week is now reality. A vote is expected to occur in one week – Thursday, June 29.

We have ONE WEEK to try to Save Our Services.

The Senate bill proposes extreme cuts to our programs:

  • Medicaid fundamentally changes into a per capita cap program beginning Fiscal Year 2020.
  • The base year calculation in the Senate version changes use of the FY16 fiscal year to an average of 8 consecutive quarters between first quarter FY14 and third quarter FY17
    • ANCOR has made the point in the Senate that several states have decade old rates so while we appreciate the effort to address, this is not helpful.
  • Importantly, the Senate version DECREASES the amount to disability programs by changing the growth rate from the House version of CPI-M + 1% for blind/disabled programs to CPI-M+1% until FY2025 and then it drops off to CPI-U from thereon out.
    • To understand the impact of this, check out this Urban Institute piece. In a nutshell, the CPI-M is projected to grow at about 3.7% over the next decade, and CPI-U is projected to grow at 2.4% over the next decade. The Senate is creating more federal “savings” with this change.

As Senator Casey (D-PA), who joined ANCOR members today to thank them for their service, reminded us today on the 18th Anniversary of Olmstead, calls to Senate offices matter and we must call and call again!

On the anniversary of the Olmstead decision, the Senate is proposing a bill that would decimate community services to people with disabilities. Without funding and supports, community integration as defined by the Americans with Disabilities Act and affirmed by the Olmstead Supreme Court decision is a broken promise.

PLEASE CALL NOW!!!