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Bob GebbiaChief Executive Officer
American Foundation for Suicide Prevention
Why Mental Health Care is Important to Suicide Prevention
What About Mental Health Parity Under
the ACA
How AFSP is Helping Consumers in the
Marketplace
Why Mental Health Care is Important to Suicide Prevention
90% of those that die by suicide have a diagnosable and treatable mental health disorder
As many as two thirds of people with depression do not seek treatment
Only 50% of persons diagnosed with major depression receive any kind of treatment
Mental Health Parity
AFSP advocated for MH Parity, passed in October 2008
Seeks to eliminate discriminatory access to mental health (MH) and substance use disorder (SUD) benefits
Incorporated into ACA, final rules issued November 2013
Plans subject to federal parity law precluded from offering MH and SUD benefits in a more restrictive way than other covered
medical and surgical benefits
ACA builds on the Mental
Health Parity and Addiction Equity Act of
2008 by including mental
health, substance use
disorder benefits in the
Essential Health Benefits
By applying federal parity protections to mental health and substance
use disorder benefits in
the individual and small
group markets
By expanding parity
requirements to millions of
Americans whose
coverage did not
previously comply with
these requirements
Copays, coinsurance, and out-of-pocket maximums
Limits on services utilization, such as number of inpatient days or outpatient visits that are covered
Coverage for out-of-network providers
Mental Health Parity Applies to:
Employer-funded plans with more than 50 insured employees
Non-grandfathered employer-funded plans with 50 or fewer employees
Individual market plans
Medicaid managed-care programs
Who Must Provide Equal Coverage?
Small employer plans created before March 2010 (these are grandfathered and exempt from the requirements)
Church-sponsored plans and self-insured plans sponsored by state and local governments
Retiree-only plans
TriCare
Medicare
Traditional Medicaid (fee-for-service, non-managed care)
Parity does not apply to:
Who is responsible for implementation?
• States have primary authority for implementation
• Center for Medicare / Medicaid has authority over compliance
The Affordable Care Act will extend federal parity
protections to 62 million Americans
Individuals who will gain mental health, substance
use disorder, benefits under the
ACA
Individuals with existing mental
health and substance use
disorder benefits who will benefit
from federal parity protections
Total individuals who will benefit
from federal parity protections
Individuals currently in individual plans
3.9 million 7.1 million 11 million
Individuals currently in small group plans
1.2 million 23.3 million 24.5 million
Individuals currently uninsured
27 million n/a 27 million
Total 32.1 million 30.4 million 62.5 million
FOR MORE INFORMATION ON MENTAL HEALTH PARITY?
www.cms.gov www.dol.gov www.samhsa.gov
Visit www.commonwealthfund.org to view an interactive map to review the status of state action on state health insurance marketplaces, also called exchanges, and view
key aspects of state-run marketplaces
AFSP PARTNERED WITH THE NATIONAL COUNCIL TO CREATE A TOOL FOR CONSUMERS LOOKING
FOR OF MENTAL HEALTH CARE
AFSP is Collaborating with the National Council for Behavioral Health
Mental Health Consumer Tools
Mental Health Parity and the ACA: Mental Health Services in the New Insurance
Marketplace
This tool:
Provides consumers with information about mental health parity and key things to consider when selecting a plan
Your Mental Health Needs and the New Insurance Marketplace!
This tool:
Provides consumers with information about how insurance plans work, basic components, coverage levels available to them, and how to select a plan that meets their mental health needs
Appeals and Exceptions: How to Access Mental Health Services in Qualified
Plans
This tool:
Provides consumers with information about how to request services or meds not covered by using: Prior Authorization Requests Exceptions Appeals
What’s Next?By early March:
• Final design will completed
• The new consumer tools will be on the AFSP and NCBH websites, and linked to other sites