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Mental health care gets a boost from ACA mandate

By Paul R. Pace, News staff

The Affordable Care Act has brought about a “huge opportunity” for behavioral care in the U.S., said Ron Manderscheid, co-chairman of the Coalition for Whole Health.

All health insurance plans sold on the federal and state insurance exchanges must offer 10 essential health benefits, or EHBs, to their enrollees, including mental health and substance-use disorder treatment. EHBs are also required for all new individual and small-group plans sold outside the exchanges. Additionally, all plans must offer mental health and substance-use benefits in parity with medical and surgical benefits.

Manderscheid said it’s important that social workers and other mental health care advocates help remove barriers to appropriate services for mental health and substance-use disorders.

“We have a wonderful opportunity here,” said Manderscheid, who is the executive director of the National Association of County Behavioral Health & Developmental Disability Directors. “We have to make sure this opportunity plays out in a positive way for those populations that have been excluded from insurance for all these years, who have behavioral health conditions and who need services.”

The Coalition for Whole Health, of which NASW is a member, has been working to ensure that all Americans have access to high-quality, affordable health care, including treatment for mental health and substance-use disorders.

In states with federally facilitated or state partnership insurance exchanges — as well as states running their own insurance exchanges — oversight and adherence to the regulations are important, Manderscheid said.

He noted that the U.S. Department of Health and Human Services would review the status of insurance exchanges adhering to the ACA’s essential health benefits mandate in 2015.

In the meantime, the coalition has sought input from its 165 member organizations, through surveys and other channels, on the degree to which mental health parity services are being implemented in qualified health plans.

One example of noncompliance with federal regulation is a qualified health plan in Iowa, which had no behavioral health providers in it, Manderscheid said.

“Those are the kind of things we want to be able to inform HHS about so they can work with the (Iowa insurance exchange) and the state of Iowa so that plans have behavioral health providers,” he said.

The coalition has been receptive in communicating any issues it has uncovered concerning mental health parity with top leaders in HHS, Manderscheid said.

The ACA requires all health plans participating in the exchanges to meet network adequacy standards, in which plans must demonstrate a sufficient number of providers in each essential health benefit category to meet enrollee needs.

Data from HHS on how well health plans are meeting network adequacy and other EHB regulations are likely a year or two away.

“Hence, the anecdotal cases (of barriers to care) become very important and opening the communication channels to allow those anecdotal cases are very important,” Manderscheid said.

More information: coalitionforwholehealth.org.

How you can help

Do you have examples of clients facing barriers to care under the Affordable Care Act? Ron Manderscheid, co-chairman of the Coalition for Whole Health, welcomes your stories at rmanderscheid@nacbhd.org.

From the July 2014 NASW News.

5 comments

  1. Well, I don’t understand why all this sounds so good for the employment outlook, and there are still no jobs in therapy, especially if you have a CSW trying to get to the LCSW. This does not add up.

  2. Wendy raises a good point: the ACA has increase costs. but has not created jobs for health and mental health providers. It’s just created more jobs for federal oversight workers. It’s also increased health insurance premiums by mandating benefits coverage for people who may not want or need those benefits.

    Professional Social Workers can lead the way to building a health and mental health care system that eliminates silos and creates a smooth, cost-effective continuum of care focuses on wellness, not disease.

  3. Yes, mental health services are provided per ACA, but I have encountered trouble being recognized as a provider. However, if you are a psychiatrist or psychologist, you will always be recognized and reimbursed.

  4. I want to challenge the belief this is a “huge opportunity” for behavioral health care in the US. In fact, I believe the very opposite is happening. The problem is that parity is maintained by putting PhD’s on one level of pay, while Medicaid is cutting the rates for master’s level therapists in half. In response many master’s level therapists are leaving the profession, or at the very least no longer taking Medicaid, myself included.
    In the following study ( http://ps.psychiatryonline.org/data/Journals/PSS/3512/504.pdf ) 33.6% of mental health services were provided by master’s level therapists. This new “parity” has the potential to cut in half the professional counseling services available to the most vulnerable population. And if you have other types of insurance and hence you think you are immune, beware, reimbursement rates for providers are all dropping so low that my personal goal is to be off all insurance panels by 2019.
    Many will say social workers in particular have a responsibility to serve the most needy. However, with reimbursement rates cut so drastically, we would need to be recipients of Medicaid ourselves in order to accept those rates. After six years of college, 2 years of post graduation supervision (akin to a doctor’s residency), I would like to think I do not need to be on Medicaid when I work full time.
    It is a shame that the NASW is so supportive of a situation that ultimately drives social workers out of mental health.

  5. Yes, in the state of WV, independently practicing LICSW’s are not able to bill Medicaid directly. LICSW’s practicing in behavioral health centers are only able to bill for therapy, not assessment and diagnosis unless signed off by a psychiatrist or licensed clinical psychologist. We are undertaking a project to address this but are coming up short on “hard” evidence that Medicaid reimbursement provides access to services otherwise not available (especially in rural areas) and creates long term financial benefits for the state. Does anybody have suggestions or resources, (particularly numbers!)to share to help further this initiative? Thanks!

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