THE FUTURE OF CHILDREN S BEHAVIORAL HEALTH IN MEDICAID, CHILD WELFARE, TRICARE AND PRIVATE INSURANCE PLANS

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1 THE FUTURE OF CHILDREN S BEHAVIORAL HEALTH IN MEDICAID, CHILD WELFARE, TRICARE AND PRIVATE INSURANCE PLANS WASHINGTON, DC JUNE 15 16, 2016 With accelerating developments in service coordination and integration, testing of new reimbursement models, and widening expectations that private health plans should offer equitable coverage, this meeting convenes a timely discussion on the programs and public policies most affecting children s behavioral health care. The largest payer for mental health services, Medicaid offers a variety of demonstration opportunities to modernize service delivery, bolstered for child and youth enrollees by the underlying EPSDT mandate. A steady stream of guidance from the Centers for Medicare and Medicaid Services (CMS) provides resources on serving targeted populations, and strategies on how to combine Medicaid-covered benefits with other public health and social services to ensure the most robust coverage. Unfortunately, the Institutions for Mental Diseases (IMD) exclusion continues to impose a considerable barrier to providing a full array of services, EPSDT and the Psych Under-21 benefit notwithstanding. A significant access point for mental health services, the child welfare system continues to be the focus of reform discussions on Capitol Hill. One proposal would allow broader use of Title IV-E funds to safely prevent out-of-home placements and would create a new definition of allowable congregate care settings. How overall service capacity would be addressed remains to be fleshed out not least, in relation to Medicaid s IMD exclusion. More than two million children and adolescents in military families are enrolled in TRICARE, whose behavioral health benefits are undergoing substantial revision for the first time in 20 years. Long a top policy issue for NACBH (in fact, the reason the association was formed in the 1980s), TRICARE coverage and standards will be brought into the twenty-first century when a current proposed rule is finalized. Since that will not occur before our meeting in June, we will take the opportunity to discuss

2 what the rule proposes, and what is on the agenda for the highly effective TRICARE for Kids Coalition, of which NACBH is a member. And then there is everyone else, the millions of children insured or underinsured by private sector health plans. We have watched the incremental movement of private payment under the Mental Health Parity Act of 1996, the improvements made by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, and the expansion of the parity law s coverage under the Patient Protection and Affordable Care Act of Movement not necessarily being progress, we have tracked the challenges to full implementation, and the litigation that could gradually compel compliance. We will open the meeting with a dynamic and practical session on how to cut through the lingering resistance and begin increasing your private reimbursement. NACBH is known for frank, open discussions with key leaders and policymakers in children s behavioral health. Please join us in Washington in June, contributing your expertise and perspective to the conversation. Attached is the preliminary agenda, ending at noon on the second day to allow time for Congressional visits after we adjourn. Additional speakers from federal agencies, Capitol Hill and colleague organizations will be invited as developments between now and then warrant. HOTEL INFORMATION Loews Madison Hotel th Street, NW, Washington, DC main hotel number: (202) reservations: (855) , group code NCB613 or online: NACBH room rate: $295/night single-double, $325/night triple, $355/night quadruple Rates effective June 13 through 16 (and, subject to availability, the 3 nights before and after). Hotel cut-off date: May 20, 2016, 6:00 p.m. (Eastern). Please reserve early as the room block may sell out. A city-wide convention will make finding another hotel difficult and expensive!

3 THE FUTURE OF CHILDREN S BEHAVIORAL HEALTH IN MEDICAID, CHILD WELFARE, TRICARE AND PRIVATE INSURANCE PLANS PRELIMINARY AGENDA Wednesday, June 15, :45 a.m. Mount Vernon Registration and Continental Breakfast 8:30 9:15 a.m. Welcome and Meeting Overview Steven Girelli, Ph.D. President and CEO, Klingberg Family Centers President, NACBH Pat Johnston Executive Director, NACBH 9:15 10:30 a.m. Implementing Parity on the Ground: Strategies for Working with Private Payers Carol McDaid Principal Capitol Decisions, Inc. Washington, D.C. Understanding the potential of the federal parity and health care reform laws is essential to serving more children and families while diversifying the payer mix. Developments in Medicaid parity and managed care regulations heighten the need to build organizational capacity to work with private payers. Together, these public policies can alter the mental health coverage and reimbursement climate only if an educated and activated constituency participates in the dialogue. With more than 25 years of federal legislative and public affairs experience across the health care field Ms. McDaid s advocacy began before there was parity to implement. She served as a strategist and advisor to the Parity NOW Coalition, which was influential in the passage of the landmark Mental Health Parity and Addiction Equity Act, and consults with a variety of provider and consumer groups to ensure its practical application. Her presentation will focus on successful tactics and strategies to win health plan disputes employed by the Parity Implementation Coalition, a national coalition of mental health and addiction consumer and provider organizations. Developing health insurance literacy, adopting effective phone-based communication with health plan employees, and crafting winning appeals will all be discussed. Attendees will learn about hard-fought wins generated by a range of advocacy tactics used in and outside government, and have the opportunity to query an expert on how your organization can more effectively engage with private payers. 10:30 10:45 a.m. Break

4 10:45 12:00 noon TRICARE: Current Reform Actions and Deliberations and the Role of the TRICARE for Kids Coalition Kara Oakley, J.D. President Oakley Capitol Consulting Washington, DC NACBH participates in an unusually effective partnership of organizations representing families and providers in the military and civilian sectors, advocating for improvements in TRICARE s coverage of children s health and related services. Since its formation in 2013, the TRICARE for Kids (TFK) Coalition has gained a reputation as a cohesive and tenacious stakeholder group, opening more doors on Capitol Hill and at the Department of Defense than any of its member groups can individually. Recent military health system initiatives have converged with developments in the larger health care environment and escalating cost pressures in Congress to make 2016 the year of TRICARE reform or the beginning of a serious examination of the alternatives. Ms. Oakley, who chairs the TFK Coalition, has more than 15 years experience representing children s hospitals on all things related to military health care and serving military children and families. Her portfolio of legal training, political insight, and federal and state legislative advocacy is more than matched by the energy she brings to problem-solving and coalition-building. She will join us to provide background on the TFK Coalition s activities and plans, review the status of TRICARE reform deliberations on the Hill, and hear from attendees about issues related to behavioral health coverage for children in military families. Pat Johnston and Joy Midman will lead a discussion of NACBH s founding interest in the then-champus program and the current proposed regulations to modernize TRICARE s behavioral health services. 12:00 1:45 p.m. Lunch 1:45 3:45 p.m. Child Welfare Reform Joy Midman Senior Policy Advisor, NACBH Brooke Lehmann, MSW, J.D. and Megan Zuckerman, Esq. Partners Capitolworks, LLC Washington, DC Significant reform of the child welfare system has remained on the Congressional agenda for the past several years, gaining focus and clarity. During this session, we will discuss the formerly piecemeal approach that appears to be coalescing in a comprehensive Senate bill, the Family First Act, including implications for congregate care and residential treatment. A closed, registrant-only session to review the bill s evolution will cover earlier approaches that were discarded or refined, the elements yet to be determined (in particular, interaction with the Medicaid IMD exclusion), the bill s current status and prospects for passage, and providers questions and exploration around how reform may positively or negatively affect the existing service system. Key Congressional staff have been invited to join the group to add their perspective and engage in a discussion of the most significant outstanding issues.

5 Ms. Lehmann and Ms. Zuckerman, NACBH s government relations and advocacy partners, bring a wealth of experience and talent in children s health and mental health, child welfare, and special education. As attorneys and clinical social workers, they have worked as professional staff members on Congressional committees, in Capitol Hill offices, academic policy centers and with diverse national advocacy organizations. Their depth of knowledge across child-serving systems is particularly valuable to NACBH. 3:45 p.m. 4:00 p.m. Break 4:00 p.m. 5:15 p.m. NACBH Annual Business Meeting Open to all meeting participants. Reports of the President, Executive Director, Senior Advisor for Public Policy and government relations team, committees and work groups on the activities of the past year and priorities for the next. The membership s participation in prioritizing activities for the next year is welcome and encouraged. The Election of Officers completes the business of the meeting. 5:30 7:30 p.m. Potomac Presidents Reception We gratefully acknowledge the generous and continuing support of the Joint Commission for sponsoring this reception recognizing the leadership of NACBH, its Board and members. Thursday, June 16, :30 a.m. Mount Vernon Continental Breakfast 9:00 12:00 noon Medicaid and Children s Behavioral Health: A Conversation Melissa Harris Senior Policy Advisor Disabled and Elderly Health Programs Group Center for Medicaid and CHIP Services Center for Medicare and Medicaid Services Department of Health and Human Services Baltimore, Maryland Medicaid is a safety net for the most vulnerable children in our country, and CMS continues to be the pivotal agency of import to NACBH and providers of children s behavioral health services. Notwithstanding the expansive intent of EPSDT, an expanding array of options for outpatient, home and community-based, health homes and other services, and a consistent flow of guidance from CMS to the states, gaps in Medicaid remain. Across the Medicaid program and also affecting separately administered foster care programs, coverage is limited by the IMD exclusion. Authorities and flexibilities under an increasing variety of waivers can be difficult to unravel, and updates to one section of Medicaid regulations can have unexpected effects on others. It is enormously complex. Ms. Harris joins us again to continue our ongoing conversation with CMS on Medicaid policy and its implications for children s behavioral health care. In her more than twenty years at CMS, she has worked primarily on programs serving individuals living with disabilities, with a focus on community-based

6 alternatives to institutional placements. Her commitment is demonstrated by her availability to respond to other system partners in particular, providers on how Medicaid can be most effectively implemented under current law. Ms. Harris will provide an update on timely issues such as new Medicaid parity and managed care regulations, recent changes to home and community-based services, and evolving interpretation of EPSDT and PRTF policies. As repeat attenders look forward to each year, ample time is planned for open discussion. Relevant Congressional staff have been invited to add their perspective and query the group on key issues affecting legislation. 12:00 noon Adjournment Many thanks to the Commission on Accreditation of Rehabilitation Facilities, the Council on Accreditation, and the Joint Commission for their continuing support and participation in NACBH meetings. In deference to those who requested a fragrance-free environment, we ask that you avoid wearing perfumes, colognes and other scented products.

7 REGISTRATION FORM NACBH 2016 ANNUAL PUBLIC POLICY MEETING THE FUTURE OF CHILDREN S BEHAVIORAL HEALTH IN MEDICAID, CHILD WELFARE, TRICARE AND PRIVATE INSURANCE PLANS Loews Madison Hotel, Washington, DC, June 15 16, 2016 $695 $395 NACBH MEMBERS 1 st registrant from NACBH member agency each additional registrant from NACBH member agency REGISTRATION FEES $895 $595 NON-MEMBERS 1 st registrant from non-member agency each additional registrant from non-member agency CANCELLATION POLICY A 50% cancellation fee will be imposed for cancellations received between May 18 and June 1. Refunds will not be made after June 1. SPECIAL REQUIREMENTS Please describe any special dietary or accessibility requirements for each registrant listed below. REGISTRATION Name of agency Address 1 st registrant s name Title Address (if different from above) Phone and Special Requirements

8 2 nd registrant s name Title Address (if different from above) Phone and Special Requirements 3 rd registrant s name Title Address (if different from above) Phone and Special Requirements 4th registrant s name Title Address (if different from above) Phone and Special Requirements Please send completed form to register@nacbh.org or to: NACBH, 1025 Connecticut Avenue, NW, Suite 1012, Washington, DC Meeting registration will be confirmed and invoiced by . To whom should that be addressed? Name,