ACA mandates that treatment is offered through exchanges
The Affordable Care Act has brought about a “huge opportunity” for behavioral care in the U.S., said Ron Manderscheid, co-chairman of the Coalition for Whole Health.
All health insurance plans sold on the federal and state insurance exchanges must offer 10 essential health benefits, or EHBs, to their enrollees, including mental health and substance-use disorder treatment. EHBs are also required for all new individual and small-group plans sold outside the exchanges. Additionally, all plans must offer mental health and substance-use benefits in parity with medical and surgical benefits.
Manderscheid said it’s important that social workers and other mental health care advocates help remove barriers to appropriate services for mental health and substance-use disorders.
“We have a wonderful opportunity here,” said Manderscheid, who is the executive director of the National Association of County Behavioral Health & Developmental Disability Directors. “We have to make sure this opportunity plays out in a positive way for those populations that have been excluded from insurance for all these years, who have behavioral health conditions and who need services.”
The Coalition for Whole Health, of which NASW is a member, has been working to ensure that all Americans have access to high-quality, affordable health care, including treatment for mental health and substance-use disorders.
In states with federally facilitated or state partnership insurance exchanges — as well as states running their own insurance exchanges — oversight and adherence to the regulations are important, Manderscheid said.
He noted that the U.S. Department of Health and Human Services would review the status of insurance exchanges adhering to the ACA’s essential health benefits mandate in 2015.
In the meantime, the coalition has sought input from its 165 member organizations, through surveys and other channels, on the degree to which mental health parity services are being implemented in qualified health plans.
One example of noncompliance with federal regulation is a qualified health plan in Iowa, which had no behavioral health providers in it, Manderscheid said.
“Those are the kind of things we want to be able to inform HHS about so they can work with the (Iowa insurance exchange) and the state of Iowa so that plans have behavioral health providers,” he said.
The coalition has been receptive in communicating any issues it has uncovered concerning mental health parity with top leaders in HHS, Manderscheid said.
The ACA requires all health plans participating in the exchanges to meet network adequacy standards, in which plans must demonstrate a sufficient number of providers in each essential health benefit category to meet enrollee needs.
Data from HHS on how well health plans are meeting network adequacy and other EHB regulations are likely a year or two away.
“Hence, the anecdotal cases (of barriers to care) become very important and opening the communication channels to allow those anecdotal cases are very important,” Manderscheid said.
More information: Coalition for Whole Health.
How you can help
Do you have examples of clients facing barriers to care under the Affordable Care Act? Ron Manderscheid, co-chairman of the Coalition for Whole Health, welcomes your stories at firstname.lastname@example.org.
Lawmakers pass ‘Protecting Access to Medicare Act’
The Protecting Access to Medicare Act was passed into law on April 1 and it includes provisions of the Excellence in Mental Health Act, which NASW supported.
U.S. Sen. Debbie Stabenow, D-Mich., who is also a NASW Social Work Pioneer®, introduced the Excellence in Mental Health Act. The law calls for expanding access to community mental health services and strengthens the quality of care provided for those living with mental illness.
“Today is the last step in enacting this landmark advance in community mental health funding, but it’s just the first step on the road to making this program a reality in communities across the country,” Stabenow said in a statement. “I look forward to working closely with the administration as they select and implement the demonstration projects funded by this legislation.”
The effort establishes pilot programs in eight states to increase access to community mental health centers and improve the quality of care at those centers. Those programs could then be extended to other states.