Affordable Care Act

Nontraditional patients also affected by reform

by Sarah Fay Campbell

(Editor's note: This is eighth in a series on the Affordable Care Act.)

The majority of dialogue regarding the Affordable Care Act has been focused on treatment of illnesses, injuries and preventive medical care. However, changes to mental health and substance abuse care may prove the most transformative.

The Affordable Care Act, aka “Obamacare,” does expand "parity," or equally dispersed provisions, for mental health services for some insurance plans. The plan also requires substance abuse treatment to be included in insurance plans along with preventive care for mental health and substance abuse services, such as depression and addiction screenings.

"This is probably the most profound change we've had in drug policy, ever," Michael Botticelli, deputy director of the Office of National Drug Control Policy, told The Associated Press.

"There is no illness currently being treated that will be more affected by the Affordable Care Act than addiction," Tom McLellan, CEO of the nonprofit Treatment Research Institute and President Barack Obama's former deputy drug czar, reports. "That's because we have a system of treatment that was built for a time when they didn't understand that addiction was an illness."

Nationwide, there is a shortage of addiction treatment and drug rehab services. Current available services may now become more overloaded with those newly eligible.

"Parity" means mental health and substance abuse services must be provided under the same conditions that medical/surgical benefits — meaning insurance carriers will not be able to place limits such as "10 visits a year," or other similar stipulations, on these services.

Many large insurance plans are currently required to offer mental health services equal to medical services, under the Mental Health Parity and Addiction Equity Act of 2008. This act only applied to larger plans however, not specifically to substance abuse services.

Some plans will continue to be exempt from parity requirements: church-sponsored plans and self-insured plans through state and local governments, individual and small employer plans, retiree-only plans, TriCare, Medicare, and traditional Medicaid. In addition, according to the Substance Abuse and Mental Health Services Administration, large-group plans created before March 2010 are also "grandfathered in" and not subject to parity requirements.

With increased coverage, there will be a larger demand for mental health treatment providers, both inpatient and outpatient. According to AP, there are currently 2,590 beds at drug abuse treatment facilities in Georgia, with a 90 percent occupancy rate. 39,000 people are now receiving drug treatment, and 99,578 addicts are estimated to become newly eligible for insurance in 2014.

Already, a market research firm has found the prospect of more paying patients has prompted private equity firms to increase investments in addiction treatment companies.

As with most parts of the Affordable Care Act, the actual results remain to be seen.

"The details of specifically how it is going to impact us and the people that we serve… I'm not clear on that," said Jade Benefield, CEO of the Pathways Center. Pathways is a "community service board," a quasi-public agency that provides mental health, crisis stabilization, developmental disability and addiction treatment services in a 10-county area that includes Coweta. The facility is one of the few local mental health care providers currently accepting Medicaid. Pathways also offers a sliding fee scale for uninsured clients and receives funding for indigent care.

"It will become clearer as the months pass," Benefield said. "Our stance is that we are trying to be extremely flexible and ready to react however this turns out and however it is going to affect us as an organization."

"At the moment there's no impact but we'll be monitoring it very closely," Benefield adds. "Flexibility is the key word for us, being ready to change as the rules and the laws change."

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