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Proposed rule for the health insurance exchanges a threat to mental health and substance abuse disorder providers?
by STEPHEN HAMMILL

The federal Center for Medicare & Medicaid Services (CMS) recently released a proposed rule for the health insurance exchanges, created by the new health care reform law.

According to the Legal Action Center, it fails to identify mental health and substance abuse disorders providers as essential community providers that serve predominantly low-income and medically underserved populations. In addition, they state there are other improvements to the proposed regulation that would better ensure that the health needs of people with mental and substnce sbuse disorders are better met.

Read from their statement after the jump:

It is very important that the exchanges address mental health (MH) and substance use disorders (SUD) in the strongest way possible. Although the proposed exchange regulation includes several important MH/SUD provisions, it fails to identify MH/SUD providers as essential community providers that serve predominantly low-income and medically underserved populations. In addition, there are other improvements to the proposed regulation that would better ensure that the health needs of people with MH/SUD are well met.

As CMS collects public comment and shapes final exchange rules, it is critical that the regulators hear from the field about the need to include the strongest possible SUD/MH provisions, including adding licensed or certified SUD and MH organizations as essential community providers.

What Your Organization Can Do:

CMS is accepting public comments on the proposed exchange regulation through October 31, 2011. Please submit comments on behalf of your organization (see below) urging them to include several key provisions in the final rule, including adding licensed or certified mental health and substance use disorder organizations as essential community providers, to ensure that exchanges best meet the needs of individuals with MH/SUD. A sample model letter is available here [Word doc].

To submit comments, follow this link.

To view the proposed regulations, use this link [PDF].

Background:

The federal health care reform law, the Affordable Care Act (ACA), creates state-based health insurance exchanges for individuals and small businesses to pool risk and purchase insurance. The exchanges will play a central role in health reform's efforts to expand coverage by creating an organized, regulated marketplace for individuals and small employers to purchase insurance. The Congressional Budget Office estimates that 29 million individuals will get coverage through the exchanges when the ACA is fully implemented.

The federal Department of Health and Human Services released proposed regulations governing the exchanges and health plan participation in the exchanges in July. The proposed regulations include a number of important provisions to facilitate participation by individuals with MH/SUD needs.

The proposed regulations do not identify community MH and SUD organizations as essential community providers that must be included in health plan networks. The regulations also do not include other important provisions that would help the exchanges to adequately meet the needs of individuals with MH/SUD needs.

To ensure that the final exchange rules include the strongest possible provisions for MH and SUD services and providers, CMS must hear from as many organizations in the field as possible. Sample comments for your organization to submit are available here. Comments are due October 31, 2011.

If you have any questions, please feel free to contact Dan Belnap (dbelnap@lac.org)
or Gabrielle de la Gueronniere (gdelagueronniere@lac-dc.org) at Legal Action Center, (202) 544-5478.
Thanks for your help!

Read more on the Legal Action Center's website