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Indiana Prevention Resource Center (IPRC)

Update on the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA)

On December 16 the US Department of Health and Human Services (HHS) released a bulletin giving individual states greater flexibility in how they implement the ACA. It offers the states the possibility of substituting services. This created immediate concern that some states might reduce mental health and addiction coverage, substituting other types of benefits and services. But HHS in an accompanying press release restricted the option to the ability to make changes within a benefit category rather than across categories.

source: http://reid.senate.gov/issues/healthcare.cfm

There are 10 benefit categories that all state health plans must cover to comply with the ACA:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management, and
  10. Pediatric services, including oral and vision care

The ACA and MHPAEA offer both small businesses and individuals assurance that their chosen insurance plan will provide an affordable and comprehensive package of health services.

Each state will select a “benchmark” plan.  This plan will be selected from among already existing health care plans available in the state. Each state will select one from among:  one of the state’s three largest small-group plans, employee health plans, or federal employee health plan options; or, it can select the state’s largest HMO plan offered in its commercial market.   In other words, the state can select an already existing small-group plan, employee health plan, or federal employee health plan, or HMO as its model or ‘benchmark’ plan. Whichever plan is chosen, its benefits and services would become the essential health benefits package for that state.  At the same time, in order to comply with the Mental Health Parity and Addition Equity Act (MHPAEA), this package must cover at least the 10 categories listed above, which includes substance use disorders (SUD) and mental health (MH). If a state’s selected “benchmark” plan does not adequately cover SUD and MH benefits and services, the state must modify the plan to be in compliance.  There is no flexibility in this regard:  health care services for substance use disorders and mental health are guaranteed.  All essential benefits must be offered by 2014.

To read the HHS News Release “HHS to give states more flexibility to implement health reform” go to http://www.hhs.gov/news/press/2011pres/12/20111216c.html To read the HHS bulletin on Essential Health Benefits go to http://bit.ly/sfgzym (Note the text begins on p. 2)  (Public comments on this proposal are welcomed by HHS and are due by Jan 31, 2012 and can be sent to: EssentialHealthBenefits@cms.hhs.gov.).
For a more complete discussion, see “HHS Gives States Flexibility in Implementing Health Care Reform,” Alcoholism and Drug Abuse Weekly 24/2 (Jan 9, 2012): 1.
By Barbara Seitz de Martinez, 1/6/2012