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Healthcare Reform Law Gives Big Boost to Addiction Treatment and Prevention

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Don't count addiction recovery advocates among those who see healthcare reform as 'Armageddon': the bill signed into law by President Obama on March 23 includes addiction and mental health services in its basic benefits package and is being broadly praised by treatment, prevention and recovery leaders.

According to an analysis from the Legal Action Center (LAC), the Patient Protection and Affordable Care Act (HR 3590) requires a basic benefit package for all health plans in the individual market and small-group markets. “All such plans will be required to cover mental health and substance use disorder services,” according to the LAC, which said the measure represents a “ground-breaking expansion of addiction and mental health coverage of prevention, treatment and recovery.”

“When the law is fully implemented, 32 million Americans who are uninsured today will have access to health insurance coverage, including for addiction,” according to Faces and Voices for Recovery. “The new law builds on the principle of equity for addiction with other health conditions in the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and marks significant progress in making it possible for many more Americans to get the help they need to recover from addiction.”

“Including addiction treatment in the basic benefit for all medical insurance is a major public-health achievement,” added David Rosenbloom, Ph.D., director of Join Together. “Now we must turn our attention and advocacy to ensure that the promise is actually delivered in every community.”

The new law:

  • Requires all group and individual plans to comply with the Wellstone/Domenici Parity Act, which requires that addiction and mental-health benefits be provided in the same way as all other covered medical and surgical benefits.
  • Expands Medicaid eligibility to all Americans up to 133 percent of federal poverty, and requires that all newly eligible parents and childless adults receive basic benefits, including parity addiction and mental-health services.
  • Creates a national prevention council with the director of the Office of National Drug Control Policy as a member and alcohol and other drug addictions listed as a national priority for that council's report to Congress. 
  • Names behavioral-healthcare workers as a high priority in the bill's National Workforce Strategy section.
  • Lists addiction and mental-health providers as eligible for community health-team grants.

“National health reform fully embraces treatment for addiction and mental illness within medical care. Our challenge will be to face this opportunity,” said Eric Goplerud, Ph.D., head of the Center for Integrated Behavioral Health Policy at George Washington University. “Combined with parity, the workforce and health information technology resources from [the federal Recovery Act], the national health reform legislation sets the stage for prevention and treatment of addiction to become truly effective and truly part of the fabric of health and health care.”

Writing in the Huffington Post on March 26, Phoenix House chief clinical officer Deni Carise said that, “With parity and healthcare reform bringing substance abuse treatment into the realm of general medical care, one crucial priority is for treatment agencies to develop partnerships with medical organizations.

“In the years to come, hospitals, doctor's offices, and, in particular, Federally Qualified Health Centers will be the entrees to reaching new populations that we may never have been able to reach in the specialty care system,” said Carise. “This will also give us the opportunity to deliver new services such as brief treatments, behavioral interventions, and, for those who need specialty care, to provide appropriate referrals.”

Plenty for Prevention

While much attention has focused on the new law's impact on treatment and coordination with the general healthcare system, the healthcare-reform package also does much to advance the cause of addiction prevention because no child can be denied coverage for pre-exisiting conditions, nor can insurers drop coverage of people with preexisting conditions like addiction and mental-health problems, according to Dennis Embry, Ph.D., president and CEO of the PAXIS Institute.

“For the first time, we actually have corporate incentives for behavioral prevention,” Embry said. “Previously, there was no incentive except moral, spiritual, and ethical — something that we've been short in supply for some time.”

HR 3590 “promotes evidence-based clinical and community prevention with increased funding; incentives for local governments to improve community wellness; grants for small businesses to provide comprehensive workplace wellness; science-based nutrition information for families; and health screenings with personalized prevention plans covered by Medicare,” according to U.S. Preventive Medicine, a prevention-services provider. “The legislation also includes a pilot program to provide at-risk populations who utilize community health centers with individualized wellness plans to include nutritional counseling, physical activity plans, alcohol and smoking cessation counseling, and stress management.”

A public health and prevention fund that will provide $15 billion over 10 years to support home, school, and workplace prevention is included in the law, as well. “This new legislation promotes the development of a national prevention strategy which would align the views of most Americans with the policy and funding necessary to move toward a culture of prevention, personal responsibility and wellness,” said Ron Loeppke, M.D., vice chairman of U.S. Preventive Medicine.

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