Cause for celebration or just one victory in a long-term battle

On November 8, 2013 the Obama administration released the final rule providing guidance on how health insurance plans should implement mental health parity. In short, the rule states that mental health coverage must be equitable to how insurance plans cover other physical conditions. Restrictions accessing care and reimbursement for services can no longer be different for mental health in relation to other health care services. Additionally the ACA, more popularly known as Obamacare, requires that mental health coverage be included as an essential health benefit for plans available through the market exchange.  In short, as of January 1, 2014 private, marketplace exchange and Medicaid Expansion plans must offer mental health care and it must be with parity.

Much has been written about the ruling. Most of it positive. Bloomberg BNA states advocates are praising the rule. The National Council applauds the ruling saying it is “a huge victory for people living with mental health needs and for the nation as a whole.

CFYM has covered the topic in past blogs and has provided instructions on how to fight for your coverage rights by challenging an insurance claim denial. Carol McDaid of the Parity Implementation Coalition posted on September 19 that now is the time to become an informed, empowered, and vocal consumer. There is much work still to be done to ensure the civil rights and protection of people living with a mental health condition when it comes to access, however.

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Care for Your Mind

As we return from the Labor Day holiday and our annual tribute to the contributions of workers to the strength, prosperity, and well-being of our country, it’s fitting to take a quick look at mental health policy issues for employees. The Mental Health Parity and Addiction Equity Act of 2008 and the Patient Protection and Affordable Care Act of 2010 (ACA) presented new opportunities for people to receive mental health care from their employer-provided health coverage. The Mental Health Parity law attempts to level the field between medical/surgical health care and care for mental health and substance use disorders, while the ACA aims to open access to affordable health care, including behavioral health care services, for more people. Both of these laws come into play, in part, through employees’ health insurance benefits.

Fewer people are getting health insurance through work.

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As of the date of this post, there are 75 days until open enrollment begins on the Health Insurance Marketplace.

With the implementation of the ACA, the Health Insurance Marketplace will be your destination for figuring out how to get the best health care coverage you can within your budget.

Under the Affordable Care Act (ACA), Americans are assured access to health coverage, whether through insurance provided by your (or your spouse’s) employer, a government-administered program, or an exchange (the marketplace).

A Personalized Shopping Cart

The Health Insurance Marketplace provides personalized information about your options for health coverage and provides the mechanism to enroll. You’ll learn whether you can reduce the costs of your monthly premiums from your current coverage through private insurance plans and if you can lower your out-of-pocket costs.

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Paolo del Vecchio, M.S.W.
Director, Center for Mental Health Services
Substance Abuse and Mental Health Services Administration (SAMHSA)

Yesterday, Paolo del Vecchio told his personal recovery story and shared a set of elements that help define recovery. Today, he puts recovery into perspective with health reform.

Opportunities for Recovery under the ACA

To recover, individuals need access to quality, affordable health care and mental health services. The Affordable Care Act (ACA) expands mental health and substance use disorder benefits and parity protections to an estimated 62 million Americans and heralds a new era of hope for people with mental illnesses.

Beginning January 1, 2014, millions of uninsured Americans with mental health and substance use conditions will have access to health insurance coverage, many for the first time. In addition, thanks to the new health care law, beginning in 2014, insurers will no longer be able to deny anyone coverage because of a pre-existing mental health condition. Individuals will be able to sign up and enroll for insurance beginning in October of this year. People should go to www.healthcare.gov to find info on how to enroll.

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Senator David Carlucci
Chair, Committee on Mental Health and Developmental Disabilities
New York State Senate

On this blog a few days ago, Andrew Sperling of the National Alliance on Mental Illness raised questions about access to mental health treatments under the Affordable Care Act (ACA); and he voiced concerns about people being able to receive the specific mental health drugs they require once the health reform law is implemented.

As Mr. Sperling pointed out, restricting access to a full class of drugs and limiting prescribers’ option to one drug per class—which health plans can opt to do under ACA—can be short-sighted from an economics standpoint and disastrous from a health perspective. Without access to clinically appropriate medication, individuals with mental illness have higher rates of emergency room visits, hospitalization and other health services.

As Chair of the New York State (NYS) Senate Committee on Mental Health and Developmental Disabilities, I understand that in order to manage the health of people living with serious mental illness, patients need guaranteed access to the full range of drugs and services that are most likely to improve their health. Even more important, I recognize that no one understands a patient’s needs better than his or her healthcare provider; and it’s presumptuous—if not irresponsible—to remove decision-making authority from that provider.

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Andrew Sperling, Director of Legislative Advocacy
National Alliance on Mental Illness (NAMI)

The Patient Protection and Affordable Care Act (ACA) offers new choices for quality, reliable, low cost private health insurance and opens Medicaid to more people living with mental illness.

Under the law, all health plans are required to provide certain categories of benefits and services—so-called Essential Health Benefits (EHB). One of these is prescription drugs.

A question mark as to prescription drug coverage
While plans will be required to cover a minimum number of prescription drugs used to treat mental health conditions in a therapeutic class, each plan may choose to cover different medications; and the number of covered drugs will vary by state and by plan.  Most significant, the law does not require plans to cover all drugs in a particular therapeutic class.  As a result, medical and behavioral health plans can avoid covering specific drugs that, in your physician’s judgment, best address your needs.

This poses serious challenges for individuals who are in need of multiple drugs per class, particularly people with serious and persistent mental illness, chronic conditions and disabilities. Antipsychotic medications, for example, are not clinically interchangeable, and providers must be able to select the most appropriate, clinically indicated medication for their patients.  What’s more, physicians may need to change medications over the course of an illness as patients suffer side-effects or their illness is less responsive to a particular drug, and patients requiring multiple medications may need access to alternatives to avoid harmful interactions.

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Ron Manderscheid, Ph.D.
Executive Director, NACBHDD

Earlier this week, I outlined seven ways that the Patient Protection and Affordable Care Act (ACA) helps get individuals with mental health conditions in the door to access mental health services.

Today, I’ll examine the ways in which the ACA helps individuals retain access and benefit from individualized, consumer-centered care and services.

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Ron Manderscheid, Ph.D.
Executive Director, NACBHDD

It is said that a problem well-stated is half-solved. In my last post, I identified the significant economic, geographic, service system, and interpersonal challenges that can slow or thwart entirely the ability to get needed prevention, diagnosis, and treatment services for behavioral health conditions. I pointed out how, as a result, few people with mental health problems ever get either behavioral or physical health care services, resulting in shortened lives by as many as 25 years.

In this post, I examine ways in which the challenges to accessing behavioral health care can be overcome. In particular, I look at ways in which implementation of the Patient Protection and Affordable Care Act (ACA) is a real and vital tool to help people with mental conditions get, retain, and benefit from individualized, consumer-centered care and services.

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