published Monday, December 16th, 2013

War on drugs shifts: Health care law expands coverage for substance abuse, mental illness

Local and national coverage

This is the first in an occasional series on the 10 essential health benefits required by the Affordable Care Act.

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The U.S. Department of Health and Human Services also announced last week that it plans to direct $50 million to help regional community health centers establish or expand behavioral health services for mental illness and substance-abuse treatment.

Tennessee may be able to open another front in its war against rampant prescription drug abuse through a rule under the new federal health care law requiring health insurance plans to cover substance abuse treatment.

In what federal officials have called "one of the largest expansions of mental health and substance use disorder coverage in a generation," the Affordable Care Act will include care for mental illness and substance abuse among the 10 "essential health benefits" in insurance plans starting Jan. 1.

Plans must cover treatment for mental health and substance use disorders, prescription drugs, rehabilitative, prevention and wellness services, according to the U.S. Substance Abuse and Mental Health Services Administration. Pre-existing conditions are included.

"It allows for more access to both mental health and substance-abuse treatment, which is very big," said Brennan Francois, CEO of Parkridge Valley Hospital, which offers such treatment at three Chattanooga campuses.

"[Insurance] has been very limited in regards to covered benefits for alcohol and substance-abuse treatment. More people have to pay out of pocket for coverage in this area," Francois said.

He said the law signals a shift in how addiction recovery is viewed: Not as "luxury" or an "add-on," but as treatment for a serious illness.

Tennessee consistently lands at or near the top of national rankings of prescription drug abuse, with rates doubling over the last decade. It's the state's leading cause of accidental death, with 1,062 people dying from drug overdoses in 2011.

But finding treatment can be a challenge.

Nationally, one in 10 people addicted to drugs or alcohol, or 20.7 million people, do not receive treatment, according to a report from the National Center on Addiction and Substance Abuse.

America's current health care system does "little to effectively treat addiction," said Emily Feinstein, program director for Policy to Practice at CASAColumbia, formerly the National Center on Addiction and Substance Abuse at Columbia University in New York.

Lack of insurance coverage is a barrier to treatment, Feinstein told the Arkansas Democrat-Gazette.

"Historically, health plans have discriminated against people with addiction by limiting the type, level and amount of clinically indicated care they receive," Feinstein said.

Rather than limiting coverage to acute treatment, she said, benefits "should be comparable to benefits offered for other chronic diseases like diabetes, heart disease and asthma."

The health reform law, paired with new federal rules under the 5-year-old Mental Health Parity and Addiction Equity Act, aims to equalize such coverage.

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Despite the steps made at the federal level, some local treatment centers aren't convinced the problem is solved.

Boomer Brown, director of housing at the CADAS alcohol and drug treatment center in Chattanooga, said he is glad to see more people get coverage. But he remains concerned about how insurance companies will implement the new rules and how they may define "medical necessity" in regards to substance-abuse treatment.

For instance, he is worried that insurance may cover medical detox but not subsequent levels of inpatient and outpatient treatment that CADAS sees as necessary.

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"We just know very little about what it's going to look like at this point," he said.

Another factor, Brown said, is that Tennessee hasn't expanded its Medicaid program under the law. Many CADAS clients don't have the income to make them eligible for subsidies under the law and also probably can't get coverage through TennCare, the state's Medicaid program.

So for many of the center's patients -- about 75 percent of whom are uninsured -- the law may not make an immediate difference, Brown said.

"It may just barely open the door for them," he said.

But Brown expects an increase in patients next year whether or not the Affordable Care Act incites more people to seek treatment.

"We think there is going to be an influx next year because of the crackdown on prescription medication," Brown said. "It will force people to deal with their addiction. We're already seeing an increase in those folks."

The 56-bed facility already is full most days, Brown said.

Mental health advocates, too, are closely watching the law's impact.

Sylvia Phillips, president of Chattanooga's branch of the National Alliance on Mental Illness, said the law may have dramatic impacts for families who struggle with high insurance premiums because a member has a pre-existing mental illness.

"Premiums for one person in our family dealing with mental illness [are] the same we're paying for a family," Phillips said. "A lot of people are relying on safety-net coverage."

Phillips said her family hopes to buy a lower-cost plan on the new exchange.

Francois said one in five adults experiences mental health illness of some kind, but limited insurance coverage means it often goes untreated until there is a crisis. That makes follow-up treatments more challenging.

"We see a need for our clientele not just for their acute-care needs, but for their long-term needs," he said.

While Francois said Parkridge Valley is still in "wait-and-see mode" about the law's impact, he hopes that adding a new campus this summer -- bringing Valley's total to 172 beds -- will help meet a growing demand.

"We're holding our breath and crossing our fingers that this will actually meet the [needs of the] clients we serve," Francois said. "This would be a major coup for something we believe has long been a need."

The Arkansas Democrat-Gazette contributed to this report.

Contact staff writer Kate Harrison at kharrison @timesfreepress.com or 423-757-6673.

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