health care reform: provisions related to mental illness & substance use disorders

www.TheNationalCouncil.org

Health Care Reform: Provisions Related to Mental Illness &

Substance Use Disorders

Charles IngogliaVice President, Public Policy

National Council for Community Behavioral Healthcare

July 17, 2009


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


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


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


House Tri-Committee Bill

America’s Affordable Health Choices Act


General Provisions

Prohibits pre-existing condition exclusions

Guaranteed issue and renewal for insured plans

Ensuring adequacy of provider networks


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.



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


Senate HELP Committee Bill



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



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


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?


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.


National Council for Community Behavioral Healthcare

www.thenationalcouncil.org

[email protected]

health care reform: provisions related to mental illness & substance use disorders

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