Essential Benefits and States – 12-17-11

     There is a new wrinkle in the implementation of "essential benefits" in the Affordable Care Act, which includes mental health and substance abuse coverage.

     Instead of creating a set of standards for what the essential benefits should include, DHHS yesterday gave states the responsibility to decide what the actual benefits should be.  This means, for instance, that a state could define a mental health benefit by outcome, number of sessions, diagnosis, provider type, or any number of other factors, which most states have already done in Medicaid benefits. A mental health/substance abuse benefit must be included as an essential benefit.
 
   The importance of LCSWs making recommendations to their state on what adequate mental health benefits should include cannot be overestimated.  CSWA has been developing a template specifically for this purpose over the past year and should have it ready by March of 2012.   
 
   Standards for outpatient psychotherapy have been much less clearly defined than for inpatient mental health treatment.  It is time for LCSWs to offer our views of what these standards should include.
 
   For more detailed information on the way that essential benefits are being shifted to the states, go to http://www.nytimes.com/2011/12/17/health/policy/health-care-law-to-allow-states-to-pick-benefits.html?_r=1.  

     Please let me know if you have any questions.  I hope you all have very happy holidays.