Health Care Reform: Provisions Related to Mental Illness

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
• Americas 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.

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National Council for Community Behavioral
Healthcare

• www.thenationalcouncil.org
• ChuckI_at_thenationalcouncil.org