Table of Contents

National Health Financing News

• Senate Finance Committee Reduces Health Reform Proposal Cost, House Democrats Release Outline
• Pharmaceutical Companies Agree to Help Cover Drug Costs for Medicare Enrollees, Pledge $80 Billion to Reform the System
• HHS Report Documents Out-of-Pocket Health Care Costs
• White House Says Biotech Drugs Should be Protected from Generics for 7 Years
• Senate Report Says Insurers Failed to Provide Information on Out-of-Network Calculations
• Senator Calls for Structure Change in the VA Medical System
• House Approves Bill to End Delay in VA Health Care Financing
• President Signs Tobacco Regulation Bill
• Washington Post-ABC Poll Finds Support for Reform, Confusion and Disagreement on Specifics, and Moveable Attitudes
• Study Finds Children from “Mixed Eligibility” Families More Likely to be Uninsured
• Report Finds Small Practices Face Significant Barriers to Providing High Quality Care
• Thomson Reuters Study Finds One Quarter of Americans Struggle to Pay for Health Care
• APA Urges Broad Interpretation of Behavioral Health Legislation
• Health Care For America Now Releases Report Outlining Health Care Costs
• KFF Releases New State Health Facts Data

Download SAMHSA's Weekly Financing News Pulse: Weekly Financing News Pulse final 200900629.pdf (549.07 kb)

Table of Contents

National Health Financing News

• CBO Releases Health Reform Cost Estimates, Senate Plans Delayed; House Leaders Offer Outlines
• Ex-Legislators Release Health Care Reform Proposal
• President Obama Announces Plans to Cut More from Medicare and Medicaid
• Senators Introduce Bill to Improve Medicare Transitional Care
• Survey Finds Health Care Entities Believe Pay-For-Performance Will Improve Outcomes and Increase Cost
• State Budget Cuts Affect Children’s Health Care
• Urban Institute Brief Examines Potential Effects of Health Care Reform on Children Enrolled in Medicaid and SCHIP
• Insurers Refuse to Stop Cancelling Policies for Certain Sick Enrollees
• GE Offers Interest Free Loans to Purchase its EHR System
• VA Expands Coverage to Veterans in Priority 8
• Mathematica Examines AHRQ’s National Health Plan Collaborate
• UC-Berkeley Researchers Issue Reports Calling for Employer-Based Health Reform
• Poll Finds Americans Want Substance Abuse Treatment Included In Health Care Reform
• Polls Find Stable Support For Health Reform, Attitudes Still Movable
• PricewaterhouseCoopers Report Says Health Care Costs to Rise in 2010
• More Medical Schools Improve Conflict of Interest Policies

Around the Hill: Hearings on Health Financing

• House Energy and Commerce Subcommittee on Oversight and Investigations: Terminations of Individual Health Policies
  10:00 a.m. June 16, 2123 Rayburn
• Senate Health, Education, Labor and Pensions Committee: Health Care Overhaul
  2:30 p.m. June 16, 325 Russell
• House Energy and Commerce Subcommittee on Health: Medical Devices: Are Current Regulations Doing Enough for Patients?
  9:30 a.m. June 18, 2322 Rayburn
• House Veterans’ Affairs Subcommittee on Health: Veterans’ Health Bills
  10:00 a.m. June 18, 334 Cannon
• House Veterans’ Affairs Subcommittee on Health: VA Claim Backlog
  2:00 p.m. June 18, 334 Cannon
• House Budget Committee: Statutory PAYGO
  10:30 a.m. June 18, 210 Cannon
• House Budget Committee: Economic Case for Health Overhaul
  10:00 a.m. June 19, 210 Cannon
• Senate Finance Committee: Health Care Overhaul
  TBA June 23, 213 Dirksen
• House Natural Resources Committee: Indian Health Care Improvement Act
  10:00 a.m. June 25, 1324 Longworth

Around the States: State and Local Behavioral Health Financing News

Download SAMHSA's Financing News Pulse: Weekly Financing News Pulse final 200900622.pdf (547.66 kb)

This study of Expenditures on Clients Receiving Treatment for Both Mental Illness and Substance-Use Disorders was funded by the Substance Abuse and Mental Health Administration to address the gap in information on the cost of treating clients with these co-occurring disorders in the public sector. Although the data are from 1997, they were a rare source for studying expenditures across multiple States and multiple State agencies involved in treatment of people with M/SU conditions. The study analyzed treatment expenditures per public client in three States—Delaware, Oklahoma, and Washington State—after linking client data in each State across three public programs—mental health, substance abuse, and Medicaid agencies. Client data linked across multiple agencies were essential to understand fully the treatment of clients with such co-occurring disorders.

The study estimated expenditures on clients with co-occurring M/SU conditions and compared those with expenditures on clients with a single type of disorder—mental illness (MI only) and substance-use disorders only (SUD only). "Clients with co-occurring disorders" were defined in this study to include patients who were either receiving both MI and SUD services or had both types of diagnosis recorded by a mental health or substance abuse treatment program during 1997.

The numbers reported are estimates of expenditures made for three States with mental health and substance abuse (MH/SA) treatment services through three types of State programs—mental health (MH), substance abuse (SA), and Medicaid agencies. The expenditure estimates did not capture the spending on treatment of MI and/or SUD that may have occurred outside these programs in other State government departments (e.g., corrections, education, or child welfare) or other public or private systems or entities.

The authors highlight the following key findings regarding co-occurring conditions in this setting: substantial prevalence, higher total costs, spending greater than the sum of two treatments, use of most costly services, higher use of medications for severe mental illness (SMI), different client characteristics, primary responsibility with MH/SA agencies, highest level of spending on outpatient but not inpatient, comparable spending levels with clients with MI alone, and higher spending for youth versus adults. 

Download the full report (PDF): Expenditures on Clients Receiving Treatment for Both Mental Illness and Substance-Use Disorders Results from an Integrated Data Base of Mental Health Substance Abuse and Medicaid Agencies.pdf (738.21 kb)

This 2004 report examines mental health and substance abuse service utilization among individuals served by multiple public agencies in Delaware, Oklahoma and Washington. 

From the abstract:

This study examines the extent to which populations with MH and/or SA conditions utilize treatment services through Medicaid and State MH/SA Agencies. Data are from the SAMHSA Integrated Database, a multi-year file for three states combining Medicaid and State MH/SA Agency administrative data into a uniform database. Although populations with co-occurring conditions and those served by both Medicaid and State MH/SA Agencies have substantial contact with the public treatment system, a majority of the MH/SA populations examined here utilize few services over brief periods of time. Utilization is most limited among individuals with MH-only conditions and those served exclusively by Medicaid. While a lack of data on clinical outcomes prevents us from drawing conclusions about the effectiveness of MH/SA services, results of this analysis do indicate that public programs in the states examined here do not provide services that are primarily utilized on a frequent or chronic basis.

Download the full report (PDF): Mental Health and Substance Abuse Treatment Utilization Among Individuals Served by Multiple Public Agencies.pdf (231.15 kb)

This 1999 report provides a detailed description of the activities involved in the development of the Integrated Data Base (IDB), which integrates mental health services, drug and alcohol services, and Medicaid data for three states (Delaware, Oklahoma, and Washington).

Volume 1 describes the general concept of the data base and the detailed design including extensive file definitions and information, flow charts and crosswalks. Separate sections detail the State-specific preprocessing activities, and other aspects of the data base. These are intended to help the researcher understand the approach we took in processing data for each State and data source. Since source data received for this project varied in terms of layout and content, each was processed separately according to the contents of the file. This volume also contains appendixes with detailed information on the selection of the population and contents of the final files.

Volume 2 contains all source code used in processing the data, including programs used to load State data into SAS and routines for linking person-level data. These programs can be viewed in any text editor (such as Notepad, BBEdit, or Emacs). This code is primarily of interest to programmers and other parties interested in how files were processed and constructed. Also included in Volume 2 is the users guide, which provides users of the data base with detailed technical information regarding the structure and composition of the data base. Electronic versions of the data dictionary with State-specific documentation are also included as part of this volume. 

Download Volume 1 (PDF): IDB_Report_Volume_1.pdf (539.03 kb)

Download Volume 2 (PDF): IDB_Report_Volume_2.pdf (195.98 kb)

For this report, published in 2001, the Center for Substance Abuse Treatment (CSAT) and the Center for Mental Health Services (CMHS) of the Substance Abuse and Mental Health Services Administration (SAMHSA) initiated an effort five years ago to integrate Medicaid, State mental health, and State substance abuse agency data. Now under confidentiality agreements with the States, data from this CSAT/CMHS Integrated Data Base (IDB) Project has been analyzed and is the subject of this first report.

The IDB, currently built for the year 1996, assembles information from three types of State organizations – State MH, State SA, and Medicaid agencies. The IDB contains data from these types of organizations on mental health and substance abuse clients, their use of services, and level of expenditures. The IDB is assembled separately for three participating States –Delaware, Oklahoma, and Washington – and links person-level and service-level information across the multiple organizations in each State into one uniform data base.

This report presents findings from analyses of a subset of IDB records - persons with a primary mental or substance abuse disorder who are under age 65. Information about three groups of clients is presented: clients with mental disorders only (MH-only clients), clients with substance abuse disorders only (SA-only clients), and clients with dual MH+SA disorders (MH+SA clients). The study answers questions about the treatment services received by these populations under three different State auspices - the State MH and/or SA agency, Medicaid, or multiple auspices. 

Download the full report (PDF): Mental Health and Substance Abuse Treatment Results from a Study Integrating Data from State Mental Health, Substance Abuse, and Medicaid Agencies.pdf (381.78 kb)