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Health Care Reform: Provisions Related to Mental Illness & Substance Use Disorders

This article discusses the provisions in health care reform related to mental illness and substance use disorders, including coverage expansion, Medicaid expansion, and essential benefits packages.

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Health Care Reform: Provisions Related to Mental Illness & Substance Use Disorders

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  1. Health Care Reform: Provisions Related to Mental Illness & Substance Use Disorders Charles Ingoglia Vice President, Public Policy National Council for Community Behavioral Healthcare July 17, 2009

  2. Coverage Expansion Core to All Plans Medicaid expansion based on Federal Poverty Level Creation of Exchange/Gateway to facilitate access to public or private health insurance

  3. Impact of Medicaid Expansion “The uninsured population is primarily low-income and many have significant health care needs” ".....one in five (20%) reports a mental health problem, such as depression, bipolar disorder, autism, dementia, schizophrenia or psychosis.” Source: Medicaid as a Platform for Broader Health Reform: Supporting High-Need and Low-Income Populations, Kaiser Commission on Medicaid and the Uninsured, May 2009

  4. Impact of Medicaid Expansion Further Analysis Reveals: Fully 2.8 million have conditions severe enough that they require the intensive services provided by specialty multi-service mental health organizations like community mental health centers. This would increase the number of persons served in America's public mental health system by 50%. Source: Unmet Mental Healthcare Needs of Indigent, Uninsured Americans. National Council for Community Behavioral Healthcare, July 2009

  5. House Tri-Committee Bill America’s Affordable Health Choices Act

  6. General Provisions Prohibits pre-existing condition exclusions Guaranteed issue and renewal for insured plans Ensuring adequacy of provider networks

  7. Mental Health Provisions • Nondiscrimination in benefits; parity in mental health and substance abuse disorder benefits • Essential benefits package includes “Rehabilitative and habilitative services” as well as “Mental health and substance use disorder services” • Includes Outreach activities to educate individuals about Exchange program to include those with mental illness • Auto-enrollment - Individuals who are eligible for the Exchange are automatically enrolled in appropriate Exchange-participating health benefits plan.

  8. Mental Health Provisions • Discount pharmaceutical pricing (340B) expanded to mental health and addiction treatment organizations • Licensed Professional Counselors and Marriage and Family Therapists covered in Medicare, Rural Health Clinics, and Federally Qualified Health Centers • Eliminates 190 lifetime limit on psychiatric hospital stays within Medicare • Promotes the coordination of health services (inc. MH) through medical homes and Accountable Care Organizations • Awards grants to mental health professional training programs

  9. Senate HELP Committee Bill

  10. Mental Health Provisions • Essential health care benefits include “Mental health and substance abuse services” and “Rehabilitative and habilitative services” • More limited Parity application than House bill – applies to parity requirements to individual plans but does not broaden definition of group plans • Establishes a National Prevention, Health Promotion, and Public Health Council • Tasked with multiple objectives, inc. promoting integrated health care

  11. Mental Health Provisions • Investments in various public health programs • Inc. depression screening and tobacco cessation • Establishes a loan repayment program for mental health professionals who serve children • Awards grants to schools to recruit and train students to enter the behavioral health workforce • Creates new grant program for co-location of primary care services within mental health organizations

  12. Senate Finance Committee • Policy Papers suggest that Mental Health and Substance Use Disorder Parity required in connector • Give States option under Medicaid to develop medical homes and improve care coordination and transitional care for chronically ill enrollees. – Include Mental Health or Substance Use Disorders?

  13. Need for Medical Homes Research indicates that people with serious mental illness - which include schizophrenia, bipolar disorder, and major clinical depression – die, on average, 25 years earlier than the general population. Sixty percent of premature deaths in persons with schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious disease.

  14. National Council for Community Behavioral Healthcare www.thenationalcouncil.org ChuckI@thenationalcouncil.org

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