The Affordable Care Act: Impact on Substance Abuse Treatment

March 14, 2014 bhbhub

William C. McCormick, MBA CEO  Medivance Billing Service, Inc.

William C. McCormick, MBA
Medivance Billing Service, Inc.

Soon after this year’s holiday season, the well awaited official implementation of the 2010 Patient Protection and Affordable Care Act (ACA), will invade our national healthcare landscape. Commencing on January 1, 2014, the Affordable Care Act adjoined with its stated provisions assures to promote improvements on how patients actually should receive quality health care services, it further asserts to decrease the overall national healthcare expenditures along with expanding services for those patients with pre-existing conditions.

There have been many academic writings, medical research initiatives and scientific studies on the impact of Substance Abuse Treatment in America.  Much of the research has been very consistent by identifying that roughly 23 million Americans suffer from drug and alcohol addiction, but only a small amount actually seek the necessary treatment they need.  There were many reasons noted as to why the treatment disparity exist and leading the cause were affordability, adequate care, and access to qualified providers. The Affordable Care Act does include provisions to eradicate the barriers associated with these findings so the premise to improve and expand treatment for all those with substance abuse disorder should be a reality.

According to federal expenditure data, about 1 penny of every health care dollar in this country is spent on addiction while the demand for treatment continues to increase.  It’s unclear to me why limits of care have loomed for years on substance abuse disorders even though addiction has been classified as a disease that could be treated. With all due respect to the Wellstone-Domenici parity law (2008), under the Affordable Care Act health plans will be required to cover mental health conditions that include treatment for substance use disorders, to offer at least the same coverage as for medical conditions. In addition, the essential benefits offered in the provisions will protect healthcare coverage for those patients suffering from addiction by ensuring their pre-existing condition will not be denied by health plans.

In conjunction with celebrating my birthday last week, Health and Human Service Secretary Kathleen Sebelius announced new rules that will strengthen the mental health parity law. As described the parity law will require doctors and insurers to treat mental and behavioral related illness the same as physical illness. All patients regardless of their diagnosis will have similar co-payments and equitable deductibles coupled with parity for inpatient, outpatient and residential treatment.

The Affordable Care Act will impact the behavioral health landscape for patients, providers, and payers in many ways, but to what definitive degree no one actually knows right now, but my speculations is that more people battling these addictions will gain access to quality treatment, and providers will experience a significant growth in their facilities while insurance carriers will need to be monitored to ensure compliance with the provisions described in the law.

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