Unless you're Rip Van Winkle, you know that health care reform has become law. But not enough has been written about the positive steps the law takes to expand and improve mental health and substance use coverage and services.

Mental health care and addiction treatment are included on the list of essential benefits that must be covered in new plans offered to the uninsured through the state exchanges. In addition, these plans must comply with the federal mental health parity law.

I think we will look back at the passage of the Wellstone-Domenici parity legislation as a watershed event. The law created a platform for advocates to push for mental health and substance use coverage in reform.

Another important change has to do with Medicaid. The law expands eligibility for benefits, but those newly eligibly through the expansion will receive benefits modeled on the private insurance packages. That means the requirement for providing mental health and substance use benefits and the principle of parity will apply to these new insurance enrollees

The law also takes important steps to improve care coordination. A new Medicaid state plan option is established to permit enrollees with at least two chronic conditions or at least one serious mental health condition to designate a provider (which could be a community mental health center) as a health home. A new grant program will support co-location of primary and specialty care services in community-based mental and behavioral health settings. Another grant program will fund community health teams to support primary care practices with interdisciplinary resources including access to mental health and addiction treatment specialists.

Another program will develop, test, and disseminate shared decision-making tools to facilitate collaboration between patients, caregivers, and clinicians and incorporation of patient preferences and values into treatment decisions. A new office will work to integrate Medicare and Medicaid benefits for people enrolled in both programs and improve coordination between the federal government and states.

Several months ago I wrote about prevention and opportunity to realize advances in science within health reform. The new law takes important steps toward this goal. A new initiative will be established to coordinate federal activities and develop a national strategy. A new fund will be established for prevention and public health programs and a grant program will support delivery of community-based prevention and wellness services. Funding will be provided for early childhood home visitation programs and school-based health clinics with the requirement that they include mental health and substance use assessments, treatment and referrals.

Workplace wellness programs are also promoted. And there is more flexibility for employers to lower premiums or offer other incentives for employees who participate in wellness programs.

Other parts of the law will fund a new federal initiative to combat postpartum depression through a public education campaign; a new grant program will provide medical and support services for individuals with or at risk of postpartum conditions. And a Centers of Excellence on Depression grant program will support innovative interventions through services research.

These really are groundbreaking steps that will expand access, improve quality, and help in the prevention of mental health and substance use conditions. Now we have to make sure the law works.

About the Author

David Shern, PhD

David Shern, Ph.D., founded the National Center for the Study of Issues in Public Mental Health. He currently heads Mental Health America.

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