How the Affordable Care Act and Mental Health Parity and Addiction Equity Act Greatly Expand Coverage of Behavioral Health Care

2014 ◽  
Vol 41 (4) ◽  
pp. 410-428 ◽  
Author(s):  
Kirsten Beronio ◽  
Sherry Glied ◽  
Richard Frank
2020 ◽  
Vol 17 (02) ◽  
Author(s):  
Navita Kalair ◽  
Clio Korn ◽  
Larissa J. Maier ◽  
Thomas Pospiech ◽  
Neiloy R. Sircar ◽  
...  

One in six adults in California experience a mental illness, but up to 63% may not receive mental health services (California Health Care Foundation 2018). The treatment gap is even larger for people with substance use disorders (SUDs), and lack of treatment can lead to increased rates of suicide, homelessness, and incarceration (Weiner 2019a). Mental health parity laws require health insurance companies to cover mental and physical health services equally. These laws have helped reduce individual costs for mental health and SUD treatment (Ettner et al. 2016), but recent reports emphasize that California has not yet achieved full parity (Davenport, Gray, and Melek 2019; Parity Track 2019a; Weiner 2019b). Insurers commonly circumvent parity laws when denying behavioral health claims due to lack of “medical necessity,” a determination created by the insurer that lacks sufficient government oversight. We identify three issues with definitions of medical necessity and propose policy solutions that will 1) align medical necessity criteria with current scientific and medical standards, 2) regulate the influence of financial self-interest in assessing medical necessity, and 3) improve transparency of medical necessity criteria to clients. These solutions will help increase access to equitable, client-centered behavioral health care in California.


2018 ◽  
Vol 53 (6) ◽  
pp. 4584-4608 ◽  
Author(s):  
Amber Gayle Thalmayer ◽  
Jessica M. Harwood ◽  
Sarah Friedman ◽  
Francisca Azocar ◽  
L. Amy Watson ◽  
...  

2019 ◽  
Vol 26 (1) ◽  
pp. 102-111 ◽  
Author(s):  
Michael J Hasselberg

BACKGROUND: Technology is disrupting every modern industry, from supermarkets to car manufacturing, and is now entering the health care space. Technological innovations in psychiatry include the opportunity for conducting therapy via two-way video conferencing, providing electronic consultations, and telementoring and education of community health care providers. Use of mobile health applications is also an expanding area of interest and promise. OBJECTIVE: The purpose of this article is to review the evolution and pros and cons of technology-enabled health care since the digital movement in psychiatry began more than 50 years ago as well as describe the University of Rochester’s innovative digital behavioral health care model. METHODS: A review of the literature and recent reports on innovations in digital behavioral health care was conducted, along with a review of the University of Rochester’s model to describe the current state of digital behavioral health care. RESULTS: Given the lack of access to care and mental health professional shortages in many parts of the United States, particularly rural areas, digital behavioral health care will be an increasingly important strategy for managing mental health care needs. However, there are numerous hurdles to be overcome in adopting digital health care, including provider resistance and knowledge gaps, lack of reimbursement parity, restrictive credentialing and privileging, and overregulation at both the state and federal levels. CONCLUSIONS: Digital health innovations are transforming the delivery of mental health care services and psychiatric mental health nurses can be on the forefront of this important digital revolution.


2019 ◽  
Vol 35 (2) ◽  
pp. 101-109
Author(s):  
Deborah Swavely ◽  
David T. O’Gurek ◽  
Veronica Whyte ◽  
Alexandra Schieber ◽  
Daohai Yu ◽  
...  

This study examined a program focused on integrating mental health in a family medicine practice in an economically challenged urban setting. The program included using a behavioral health technology platform, a behavioral health collaborative composed of community mental health agencies, and a community health worker (CHW). Of the 202 patients screened, 196 were used for analysis; 56% were positive for anxiety, 38% had scores consistent with moderate to severe depression, and 34% were positive for post-traumatic stress disorder. There was a statistically significant difference in the diagnosis of depression when comparing the screened group to a control group. Only 27% of patients followed through with behavioral health referrals despite navigational assistance provided by a CHW and assured access to care through a community agency engaged with the Behavioral Health Alliance. Further qualitative analysis revealed that there were complex patient factors that affected patient decision making regarding follow-up with behavioral health care.


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