News /Hyde: Health care reform to offer new opportunities for consumers
By Shannon Eliot
The Affordable Care Act will give consumers more opportunities than ever to get customized support for their recovery, according to Pam Hyde, Administrator for the Substance Abuse and Mental Health Services Administration.
In the opening keynote of the 2012 Alternatives conference, Hyde reflected on previous models of care and the new importance of integrating behavioral and primary health care to meet the needs of the whole person.
"The goal is no longer mandated or coerced treatment for a mental health challenge," Hyde said. "The goal is overall health."
While behavioral health issues affect most Americans, their effects are not purely psychological. It is becoming increasingly difficult to isolate behavioral from physical health issues, as one so often affects the other.
Behavioral health conditions increase risks for other diseases, contribute to premature death and preventable illnesses, and are responsible for a high proportion of pediatric visits and community hospital stays and readmissions, according to Hyde. Additionally, more deaths occur from behavioral health-related conditions than breast cancer, HIV/AIDS, and traffic accidents combined.
In an effort to address the whole person, the Affordable Care Act mandates that mental health and substance abuse disorder services, including behavioral health treatment, are included in non-grandfathered individual insurance plans beginning in 2014. The legislation expands the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). While MHPAEA required parity if a plan happened to offer behavioral health or substance abuse treatment, it didn’t require that insurance plans offer such treatment in the first place.
Additionally, the application process for coverage will be getting easier. Beginning in 2014, consumers will utilize a simpler, more streamlined approach. Users will use a single application as a gateway to all coverage programs with a "no wrong door" eligibility model. Interview requirements are prohibited, and the application will be available online, by mail, by telephone through a call center, or in person.
This new method is a sharp contrast to current practices where applicants need different applications for different programs, are required to interview in person, are sent back to the beginning if denied, and only have applications available on paper or as online PDFs.
It is estimated that the law will provide access to coverage for 32 million Americans who are now uninsured, according to SAMHSA.
"We are changing from the assumption of 'if you have a certain disability, are at a certain poverty level, or have another disadvantage you can't get coverage' to 'anybody should get coverage in some form or other,' whether through Medicaid, exchanges, or employer-offered services," Hyde said.
And while many consumers, providers, family members, and allies see this legislation as a victory for the mental health community, Hyde acknowledges that there are still decisions to be made at the state level as to what those services look like. As a result, she encourages each person to learn, participate, and advocate.
"Each state will be making some decisions about this differently," Hyde said. "We need you to understand how things will work in the new Affordable Care plans. We need you to participate not only with other consumers, but other people in recovery, mental health advocates, health care advocates, disability advocates, and other stakeholders. We need to advocate both individually and collectively."
With an increase in the number of treatment options for consumers, Hyde believes the Act represents a fundamental shift in thinking when it comes to treating someone with a mental health challenge.
"These developments overcome the historical assumption that people with behavioral health issues cannot possibly know what they need to get and stay well," Hyde said.
While disagreement with a proposed treatment was once generally associated with lack of insight or denial, Hyde believes it is actually the beginning of one's recovery.
"I have been told by some of the best consumers that a disagreement with treatment may actually be the beginning of recovery," Hyde said. "I am not preaching for you to ignore your doctor, but beginning the process of taking responsibility for your own symptoms, your own health, your own wellness, and own well-being is in fact part of the recovery process. Consumers must understand what treatment options there are and make good treatment decisions for him- or herself."
According to SAMHSA1, the new law will:
- Fundamentally change what services will be available to individuals that have mental health and addiction disorders. Various provisions will require benefit packages that include treatment for mental health and substance use disorder services, prescription drugs, rehabilitative, habilitative, and prevention and wellness services. These services must be available in benefit packages by Fiscal Year (FY) 2014.
- Expand access to prevention services, including annual wellness visits, and include outreach and education campaigns. In addition, grants will be available to implement, evaluate, and disseminate community prevention activities.
- Create additional incentives to coordinate primary care, mental health, and addiction services. In FY 2011, grants and Medicaid reimbursement will be available for the creation of health homes for individuals with chronic health conditions, including mental illness and substance use disorders.
- In addition, grants will be available to school-based health centers that will offer mental health and addictions services. Grants may also be available in FY 2011 to programs co-locating primary and specialty care.
- Enhance community-based service options for individuals with a mental health and/or substance use condition. Medicaid state plan changes and demonstration grants will expand these services for individuals who have longterm care needs (e.g., dual-eligibles, high-risk Medicare beneficiaries, 1915i changes, Money Follows the Person). In addition, the CLASS Act* creates a self-funding initiative for individuals who need home- and community-based services. Some of these initiatives begin in FY 2010.
- Develop capacity to provide services in an effective and modern mental health and substance use system through various workforce initiatives, including education and training grants, loan repayment programs, and primary care residency training.
1. From http://www.samhsa.gov.