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Affordable Care Act Toolkit: MHA

What is the Affordable Care Act?

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The Patient Protection and Affordable Care Act (the "Affordable Care Act," or "ACA") (P.L. 111-148) is expected to expand health care coverage to an additional 32 million individuals through a combination of new health insurance marketplaces (formerly referred to as exchanges) and a state's option to expand Medicaid. In addition, the ACA includes a number of critical protections for consumers or beneficiaries, as well as provisions to improve the quality of care while bending the curve of health care costs.

The ACA takes ground-breaking steps toward improving access to mental health and substance use disorder treatment services. Significantly, ACA compels equal coverage of mental health and addiction services that were borne out of the enactment of the Mental Health Parity and Addiction Equality Act. Mental health and addiction services are among the 10 categories that serve as components of the "Essential Health Benefits (EHB)" package that must be offered in the marketplace. With the enactment of ACA, America has the ability to create a reformed health care system that provides comprehensive, culturally, and linguistically appropriate behavioral health services and supports. Furthermore, ACA provides the behavioral health services on par with physical health services; and it allows for the availability of preventive services at no cost to the beneficiary.

Key Facts about the Affordable Care Act Implementation

  • Enrollment opens October 1, 2013, with coverage beginning on or after January 1, 2014
  • More affordable coverage, with no lifetime limits
  • No insurance discrimination against individuals with pre-existing conditions
  • Covers all preventive services at no cost to the beneficiary
  • The Marketplaces will be administered by State, Federal, or a State/Federal Partnership, which may impact the health insurance products available in your state Ensures equality in mental health and addiction care and coverage
  • Essential health benefits (EHB): ambulatory services; emergency services; hospitalization; pre, peri-, and neonatal care; mental health and substance use disorder services; rehabilitative services; laboratory services; chronic disease management; and pediatric services
  • Individuals at or below 250% of the federal poverty level qualify for cost-sharing reductions
  • In 25 states, individuals at or below 138% of the federal poverty level will qualify for Medicaid
  • In all 50 states individuals between 139-400% of the federal poverty level will qualify for advanced premium tax credits to assist them in paying monthly premiums

Resources


Enrollment: Connecting individuals to health insurance through the marketplaces

If you are a professional learning about the Marketplace and helping people apply, get the latest resources here at www.healthcare.gov. A variety of organizations are working to support education and outreach about enrollment in the Marketplace. These organizations have materials for both consumers and other individuals enlisted to help them.

Enroll America is working to maximize the number of people who sign up for coverage under the ACA. You can also access their new website, Get Connected America, which will help achieve this goal. Enroll America has fact sheets, planning guides and other resources to facilitate enrollment.
http://www.enrollamerica.org

Families USA is a non-profit, non-partisan organization that works in concert with a wide range of organizations toward the achievement of health care that is high-quality and affordable for all Americans.
http://www.familiesusa.org/assets/pdfs/health-reform/Enrollment-Policy-Provisions.pdf

The Kaiser Family Foundation (KFF) provides information to consumers and providers on the major health issues facing our nation and its people.
http://kff.org/aca-consumer-resources/


Navigators: Navigators will work with individuals to better understand their new health insurance options and assist with enrollment.

Enroll America is working to maximize the number of people who sign up for coverage under the ACA. You can also access their new website, Get Connected America, which will help achieve this goal.
http://www.enrollamerica.org/best-practices-institute/assistance-resource-center

Healthcare.gov is the site individuals will use to apply for coverage under the ACA if they are in a state where the federal government is running the marketplace. If you're not in one of those states it will direct you to the appropriate website for your state. HealthCare.gov also contains other valuable resources, including tools for specific populations.
http://www.healthcare.gov/


Peer Services and Recovery: Services that will support recovery and community inclusion

Mental Health America (MHA) is a powerful voice for change that is made up of thousands of individuals nationwide who take an active role in protecting America's mental health. Through a several webinars and comments, they have continued to advocate and educate on systems for navigators and other peer services.
Our Webinars Page
Position Statement 37

The Association for Behavioral Health and Wellness (ABHW) is the national voice for specialty behavioral health and wellness companies. ABHW supports effective federal, state and accrediting organization policies that ensure specialty behavioral health organizations (BHOs) can continue to increase quality, manage costs and promote wellness.
http://www.abhw.org/issues/

The Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities (Temple Collaborative) is a rehabilitation research and training center assigned to conduct state-of-the-art research and knowledge translation activities to improve opportunities for community inclusion of people with psychiatric disabilities.
http://tucollaborative.org/

The Community Anti-Drug Coalitions of America (CADCA) is a national substance abuse prevention organization, working to empower community-based coalitions and represent their interests at the national level.
http://www.cadca.org/

Family Voices aims to achieve family-centered care for all children and youth with special health care needs and/or disabilities. Family Voices provides families with tools to make informed decisions, advocate for improved public and private policies, build partnerships among professionals and families, and serve as a trusted resource on health care.
http://www.familyvoices.org/


Essential Health Benefits (EHB): Making sure that your coverage of the 10 EHB is recovery oriented

The Coalition for Whole Health (CWH) website provides resources for analyzing and responding to the essential health benefits in your state's benchmark plan.
http://www.coalitionforwholehealth.org/

The National Conference of State Legislatures (NCSL) is a bipartisan organization that serves the legislators and staff. NCSL provides research, technical assistance and opportunities for policymakers to exchange ideas on the most pressing state issues.
http://www.ncsl.org/issues-research/health/american-health-benefit-exchanges.aspx

The Substance Abuse and Mental Health Services Administration (SAMHSA) exemplifies a good and modern mental health system that provides a continuous line of treatment for both mental health and addiction issues. Furthermore, it provides consumers with an integrated system of primary and behavioral health care that is affordable, accountable, organized and improves quality.
http://beta.samhsa.gov/sites/default/files/good_and_modern_4_18_2011_508.pdf

The Kaiser Family Foundation (KFF) provides information to consumers and providers on the major health issues facing our nation and its people.
http://kff.org/health-reform/issue-brief/medicaids-new-health-home-option/

The National Health Law Program (NHeLP) protects and advances the health rights of low income and underserved individuals. NHeLP advocates, educates and litigates at the federal and state level.
http://www.healthlaw.org/index.php?option=com_content&view=article&id=703&Itemid=516

The National Women's Law Center (NWLC) works to advance the issues that cut to the core of women's lives in education, employment, family and economic security, and health and reproductive rights.
http://www.nwlc.org/resource/getting-coverage-you-deserve-what-do-if-you-are-charged-co-payment-deductible-or-co-insuran


The Marketplace: How to purchase or qualify for health care coverage in your state

If you're a professional learning about the Marketplace and helping individuals apply, get the latest resources here at www.marketplace.cms.gov.  

The Center on Budget and Policy Priorities (CBPP) is one of the nation's premier policy organizations working at the federal and state levels on fiscal policy and public programs that affect low- and moderate-income families and individuals.
http://www.cbpp.org/files/CBPP-Analysis-on-the-Status-of-State-Exchange-Implementation.pdf

The National Conference of State Legislatures (NCSL) is a bipartisan organization that serves the legislators and staff. NCSL provides research, technical assistance and opportunities for policymakers to exchange ideas on the most pressing state issues.
http://www.ncsl.org/issues-research/health/american-health-benefit-exchanges.aspx

The Robert Wood Johnson Foundation (RWJF) is devoted to the public's health. Their efforts focus on improving both the health of everyone in America and their health care, including how it's delivered, how it's paid for, and how well it does for patients and their families.
http://www.rwjf.org/en/topics/search-topics/A/affordable-care-act-aca.html?t=topics%3A1633

The Kaiser Family Foundation (KFF) provides information to consumers and providers on the major health issues facing our nation and its people.
http://kff.org/health-reform/issue-brief/medicaids-new-health-home-option/


Parity: Making sure that care for mental health and substance use conditions is fully covered and accessible

The Parity Implementation Coalition (PIC) has information about the federal law and links to information about state parity laws and making complaints.
www.parityispersonal.org

The National Association of Insurance Commissioners (NAIC) assists state insurance regulators, individually and collectively, in serving the public interest and achieving fundamental insurance regulatory goals in a responsive, efficient and cost effective manner.
http://www.naic.org/index_health_reform_section.htm

The Association for Behavioral Health and Wellness (ABHW) is the national voice for specialty behavioral health and wellness companies. ABHW supports effective federal, state and accrediting organization policies that ensure specialty behavioral health organizations (BHOs) can continue to increase quality, manage costs and promote wellness.
http://www.abhw.org/issues/

The Coalition for Whole Health (CWH) website provides resources for analyzing and responding to the essential health benefits in your state's benchmark plan.
http://www.coalitionforwholehealth.org/resources-for-local-advocates/mental-health-and-addiction-parity/

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides consumers, advocates, and health care professionals with resources for information about the federal law.
http://beta.samhsa.gov/health-reform/parity


Medicaid Expansion: The status of expansion in your state and how to access coverage

Families USA is a non-profit, non-partisan organization that works in concert with a wide range of organizations toward the achievement of health care that is high-quality and affordable for all Americans.
http://www.familiesusa.org/

The Center on Budget and Policy Priorities (CBPP) is one of the nation's premier policy organizations working at the federal and state levels on fiscal policy and public programs that affect low- and moderate-income families and individuals.
http://www.cbpp.org/research/index.cfm?fa=topic&id=71

The Kaiser Family Foundation (KFF) provides information to consumers and providers on the major health issues facing our nation and its people.
http://kff.org/health-reform/issue-brief/medicaids-new-health-home-option/

The National Health Law Program (NHeLP) protects and advances the health rights of low income and underserved individuals. NHeLP advocates, educates and litigates at the federal and state level.
http://www.healthlaw.org/index.php?option=com_content&view=article&id=703&Itemid=516

The Georgetown Center for Children and Families examines policy development and implementation efforts related to Medicaid, the Children's Health Insurance Program (CHIP) and the Affordable Care Act.
http://ccf.georgetown.edu/  


Network Adequacy: Now that you are covered, are there a sufficient number of practitioners and services in close proximity when you need them?

The Parity Implementation Coalition (PIC) has information about the federal law and links to information about state parity laws and making complaints.
www.parityispersonal.org

The National Committee on Quality Assurance (NCQA) provides basic information on what network adequacy is, and how we can help to further ensure the smooth transition into ACA implementation.
http://www.ncqa.org/Portals/0/Public%20Policy/Exchanges&NetworkAdequacy_2.11.13.pdf

The National Association of Insurance Commissioners (NAIC) assists state insurance regulators, individually and collectively, in serving the public interest and achieving fundamental insurance regulatory goals in a responsive, efficient and cost effective manner.
http://www.naic.org/documents/committees_b_related_wp_network_adequacy.pdf

The National Women's Law Center (NWLC) works to advance the issues that cut to the core of women's lives in education, employment, family, and economic security, and health and reproductive rights.
http://www.nwlc.org/resource/exchange-issues-important-women

The Association for Behavioral Health and Wellness (ABHW) is the national voice for specialty behavioral health and wellness companies. ABHW supports effective federal, state and accrediting organization policies that ensure specialty behavioral health organizations (BHOs) can continue to increase quality, manage costs and promote wellness.
http://www.abhw.org/issues/


Public Health: Improving health outcomes in public health and community settings

The American Public Health Association (APHA) aims to protect all Americans, their families, and their communities from preventable, serious health threats and strives to assure community-based health promotion and disease prevention activities and preventive health services are universally accessible in the United States.
http://www.apha.org/

The Trust for America's Health (TFAH) is an organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.
http://healthyamericans.org

The Robert Wood Johnson Foundation (RWJF) is devoted to the public's health. Their efforts focus on improving both the health of everyone in America and their health care, including how it's delivered, how it's paid for, and how well it does for patients and their families.
http://www.rwjf.org/


Universal: General information about the Affordable Care Act (ACA)

Mental Health America (MHA) is a powerful voice for change that is made up of thousands of individuals nationwide who take an active role in protecting America's mental health through legislative advocacy.
http://www.mentalhealthamerica.net/

Healthcare.gov is the site individuals will use to apply for coverage under the ACA if they are in a state where the federal government is running the marketplace. If you're not in one of those states, it will direct you to the appropriate website for your state.
http://www.healthcare.gov/

The Kaiser Family Foundation (KFF) provides information to consumers and providers on the major health issues facing our nation and its people.
http://kff.org/  

The National Academy for State Health Policy (NASHP) is an independent academy of state health policymakers helping states achieve excellence in health policy and practice. A non-profit and non-partisan organization, NASHP provides a forum for constructive work across branches and agencies of state government on critical health issues.
http://nashp.org

State Refor(u)m has interactive maps on status of exchange and a variety of discussion groups surrounding the implementation of ACA.
https://www.statereforum.org/alltopics/346

Bazelon Center for Mental Health Law protects and advances the rights of adults and children who have mental disabilities. Bazelon pursues a progressive mental health policy agenda particularly at the federal level, to reform systems and programs to protect the rights of children and adults with mental disabilities.
http://www.bazelon.org/Where-We-Stand/Access-to-Services/Health-Care-Reform.aspx

Protect Your Care is an organization that will create the political and media space for elected officials, industry leaders and community advocates to champion the Affordable Care Act and hold accountable those who seek to take those benefits away by repealing or defunding the la
http://www.protectyourcare.org/

The Center for Consumer Information and Insurance Oversight (CCIIO) is charged with helping implement many provisions of the Affordable Care Act. This website has a variety of resources and fact sheets about the Act.
http://cciio.cms.gov/

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides consumers, advocates, and health care professionals with resources for information about the federal law.
http://beta.samhsa.gov/health-reform/parity

The National Council for Behavioral Health (National Council) is the unifying voice of America's community mental health and addictions treatment organizations. Together with our 2,000 member organizations, we serve our nation's most vulnerable citizens
http://www.thenationalcouncil.org/  


Lists to Join (among others)

cmslists@subscriptions.cms.hhs.gov
subscriptions@hhs.gov
newsdigest@rwjfmail.org
 

 

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