The Obama administration Nov. 8 released long-awaited rules that require health plans to treat alcoholism, addictions and mental illness on par with other physical ailments. According to the U.S. Department of Health and Human Services (HHS) brief on the Affordable Care Act – slangily called ObamaCare – the nation is poised for the “largest expansion in substance use disorder coverage in a generation.” Under the new law, next year all new small group and individual health plans are required to cover treatment for alcohol abuse and the disease of alcoholism and do so at parity with other medical and surgical benefits.
In commenting on new final rules for the expansion of healthcare coverage, HHS noted one in three of those currently covered in the individual health plan market has no coverage for alcohol use or other substance use disorders. Nearly one in five presently has no coverage for mental health services.
Individuals with the coverages today may have gaps compared to coverage for medical or surgical procedures. HHS estimates that 3.9 million individual plan participants today will gain either mental health or substance use coverage or both. “We also estimate that 1.2 million in small group plans will receive (benefits) under the Affordable Care Act.” Further, the agency added that one in four Americans who lack health insurance coverage altogether today have a mental health condition, a substance use disorder, or both.
Expansion of coverage in general, as well as to those who presently have no alcohol or drug treatment access at all today, is expected to bring about a dramatic shift in the delivery of services. With as much as eight percent of the population alcoholic, and three times as many abusing alcohol, the new law forces an evaluation of the type of services delivered, the venues where they are delivered, the individuals who will receive the services, the work force that delivers the services and how services are measured/evaluated.
The new statute’s expanded coverage could also mean more is put into drug and alcohol misuse prevention. Today, almost $223 billion is lost to the U.S. economy from alcohol use disorders alone. The figure includes lost productivity and corrections as well as health and other social costs.
Beginning January 1, 2014, all plans are required to view substance use disorder treatment as an Essential Health Benefit according to the final rule. Essential Health Benefits also will be extended to the previously uninsured.
The final rule also closes gaps in parity rules for 30.4 million insured Americans, meaning their older plans will cover benefits for substance use disorders to the same level of general medical and surgical coverages.
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