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Obamacare Sparks a Mental Health Care Revolution
Core Coverage for Mental Illness
Beginning in January, health plansmust cover a set of core benefits:
- mental health and substance abuse treatment
- prescription drugs
- rehabilitative and habilitative treatment. Habilitative treatment serves patients with developmental, cognitive, and mental health conditions by helping them learn and keep life skills and functions needed on a daily basis.
- wellness and prevention services
While the core benefit categories are required, the specific care within these categories will differ from state to state. For example, coverage for mental health and addiction treatment other than inpatient or outpatient care, such as crisis services or mental health screening in primary care, will vary depending on where you live. Also, different plans may cover different medications within particular categories or classes of drugs.
Pre-Existing Mental Illness Coverage
A key element of this new law is that patients with mental illnesses and addictions can no longer be denied benefits or have insurance coverage dropped because of a pre-existing mental health issue. In addition, the law prohibits lifetime and annual dollar limits.
Mental Health Services Covered at Parity
The ACA, in combination with the final rule released only last month for the 2008 Mental Health Parity and Addiction Equity Act, are meant to provideequaltreatment.
Starting January 1, all new plans, including individual and small group plans and plans offered on the Health Insurance Marketplace, must offer coverage for mental health and substance abuse on par with other types of medical and surgical care.
But even with these broad categories of coverage, plans will vary significantly in specifics, so you should look closely at your plan for exceptions, limitations, and other restrictions, such as visit limitations, out-of-network coverage, or coverage exclusion of specific diagnoses.
A Solution for the Psychiatrist Shortage
We are on the cusp of unprecedented change in how many people in this country will get and pay for mental health services. As more people have the ability to seek quality care for mental illness and addiction, our country’s healthcare system must face the challenge of a shortage of psychiatric physicians and other mental health specialists.
More than halfof the counties in the United States don’t have a single practicing psychiatrist, and only about 1 in 10 adults with a diagnosable mental illness receive services from a psychiatrist. People are more likely to be treated by their primary care provider for a mental health concern than by a psychiatrist.
Collaborative care can help solve the shortage problem. Also called integrated care, this approach brings together mental and physical health services for patients, so that psychiatric and primary care doctors are working in close coordination with each other and with care managers (usually a licensed clinical social worker, nurse, psychologist, or therapist).
Why is this important? Overall health outcomes are positively affected when the gap is closed between mental and physical health services.
- The integration of behavioral and medical healthcare means patients get treatment earlier and more easily, and psychiatrists can reach more people in need, particularly more medically complex and challenging patients.
- Those with serious mental illnesses too often also have chronic medical conditions and they die, on average, decades earlier than the general population.
- When behavioral health problems are effectively treated, patients achieve improved quality of life, better self-care, and enhanced adherence to medical and mental health treatments.
The combination of better mental health coverage through ACA, an increase in accountable care organizations and patient-centered medical homes, and long overdue national attention to mental illness mean this is a life-changing time for so many Americans who have been stigmatized and denied equality in health coverage and benefits.
Dr. Jeffrey A. Liebermanis the current president of the American Psychiatric Association. He is the Lawrence C. Kolb Professor and Chairman of the Department of Psychiatry at Columbia University College of Physicians and Surgeons, Director of New York State Psychiatric Institute, and Psychiatrist-in-Chief at Columbia University Medical Center of the New York-Presbyterian Hospital.
Follow Dr. Lieberman on Twitter: @DrJlieberman
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