Affordable Care Act · behavioral health integration · health care reform · Integrated Care

Historic Parity Ruling Provided at Long Last

“We know so much more today, and yet the problems are still very much the same, with one exception: Recovery.  Twenty five years ago, we did not dream that people might someday be able actually to recover from mental illnesses.  Today it is a very real possibility.”  ~Former First Lady Rosalynn Carter

History was made today at the Carter Center in Atlanta. Health and Human Services Secretary Kathleen Sebelius made a long-awaited announcement at the 29th Annual Rosalynn Carter Mental Health Policy SymposiumHealth insurance companies must cover mental illness and substance abuse just as they cover physical diseases. Secretary Sebelius’s speech  may be read here in its entirety.

In 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, marking an important step forward in efforts to end discrimination in insurance coverage for mental health and substance use disorder treatment. While the act closed several loopholes left by the 1996 Mental Health Parity Act, it has taken five years to finalize the law. The 2008 act lacked clarity on how parity is to be achieved, particularly when treatment involves intensive care at physician offices or long-term hospital stays.

Today’s ruling provides clarification on how parity applies to residential treatments and outpatient care. It also ensures that copayments, deductibles, and limits on mental health benefits are not more restrictive or provide less coverage than those for medical and surgical benefits, including geographic or facility limitations. These have been tremendous barriers to treatment thus far and represent a significant triumph for the behavioral health community.

“This is the largest expansion of behavioral health coverage in a generation,” declared Secretary Sebelius. Addressing the need for adequate care for mental health has been a goal for more than 50 years, when President John F. Kennedy signed the Community Mental Health Center Act of 1963 into law.

At long last, treatment for behavioral health disorders is regarded as equal to other types of healthcare. This represents a significant achievement in behavioral health and should contribute to the ongoing effort to reduce the stigma. Millions fail to follow up with needed treatment because of stigma. With this final ruling and with movement toward integrated care, we will finally be able to improve access.

What will the world be like when people begin to actually receive that needed treatment?

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Affordable Care Act · health care reform · healthcare integration

Health Care Reform: The Affordable Care Act and Healthcare Integration

The Supreme Court decision on June 28, 2012, delivered approximately 10:15am EDT, is a boon for healthcare integration. (Though it was scary there for a few minutes when certain hasty, overanxious members of the media provided the wrong results!)

For the past few years, community behavioral health and primary care organizations have been working collaboratively to provide services for the people they serve, diligently trying to create the perfect formula for doing what is best for the healthcare needs of the people they serve, while at the same time striving to remain financially solvent. And they have done a remarkable job! But it isn’t easy…nor have their outcomes always been ideal, largely due to limited resources. Certainly not for lack of trying!

These benevolent community providers are charged with serving the most in need. This does not always translate into being adequately compensated for their efforts, however. While some have been forced to limit their services, most have managed to avoid rationing thus far through their persistence in seeking alternatives, such as creating referral agreements, co-locating, full integration, and with grant funding. In addition, many have engaged in advocating for change at the local, state, and national levels. These tenacious providers recognize that an unwavering focus on the mission is the foundation for success.

With the newly upheld Affordable Care Act, more people will have access to healthcare coverage and will not be rejected because of pre-existing conditions. Also, for the states that don’t opt out of the new Medicaid expansion, all residents below the 133 percent of the poverty line will be eligible for Medicaid coverage. Therefore, more of the people served by community providers who were previously uninsured will have healthcare coverage. This will allow the providers to be compensated for more of the services they provide, thus supporting the mission.

The ACA doesn’t provide all the answers but it is a move in the right direction. Politics aside, our healthcare system isn’t working the way it is. We need major changes. We already know that integrating behavioral health and primary care services is more economical and provides improved health outcomes. Through these health homes, individual care is coordinated. That just makes sense.  The health home approach translates into better care for fewer healthcare dollars. This is a perfect opportunity to build on a successful model.

Read the AMA Commentary by Dr. Jeremy Lazarus, AMA president, on the benefits of the ACA on healthcare integration.

With our newly upheld Accountable Care Act at the cusp of our nation’s 236th birthday, it’s a perfect time to pull together and focus on building a system that allows us to provide effective services to meet the total healthcare needs of people with behavioral health concerns in this, the land of the free and the home of the (soon t0 be) healthy.