Including Behavioral Health in Essential Health Benefits

by Rebecca Farley on August 25, 2011

The National Council has joined the Bazelon Center for Mental Health Law, Mental Health America, and the National Association of State Mental Health Program Directors in submitting recommendations to the Department of Health and Human Services on what types of benefits should be included in the essential benefits package under health reform.

The Affordable Care Act requires that all health insurance plans offered in the state health insurance exchanges – along with Medicaid benchmark plans – offer at least a minimum set of essential benefits. The essential benefits package must include mental health and substance abuse services at parity with other medical/surgical care, along with prevention services and rehabilitative services – yet the law did not specify specific benefits that must be covered.

Our groups’ recommendations aim to strike a balance between a very narrow benefit that will leave many without essential services and the comprehensive benefits that are covered only by Medicaid. We recommend a skeleton basic benefit, but also suggest that plans be given additional guidance on evidence-based services that can offset unnecessary institutionalization or future treatment costs. The services that we recommend for coverage under the essential benefits package include: 

  • Inpatient hospital services for mental illness in an accredited institution (plans must comply with federal parity regulation)
  • Routine outpatient mental health and substance use services furnished by a licensed practitioner, including psychotherapy and medication management including management of adverse side effects (plans must comply with federal parity regulation)
  • Psychotropic and addiction medications (plans must comply with federal parity regulation)
  • Psychiatric rehabilitation services consisting at least of skills training to address functional impairments resulting from a serious mental illness, which shall be furnished in any appropriate setting (including on-the-job-site or in the home).
  • Screening for suicide ideation in depressed patients
  • Patient and family education and self-management assistance for persons with physical and mental disabilities
  • Intensive case management
  • At least one service designed to avoid institutional placement for chronic and serious mental disorders both for children and adults in order to ensure a sustainable, successful outcome (stability or remission) of a serious or chronic condition.
  • Peer support services

We also recommend additional stipulations that provide plans with guidance as to the scope of services that must be offered, chronic disease management, and non-discrimination.

The National Council also supported comments submitted by the Coalition for Whole Health, a partnership of national addictions and mental health organizations. The Coalition submitted a detailed list of recommendations to HHS outlining the full complement of services it recommends for inclusion in the essential health benefits package.

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