Coalition for Whole Health Comments on Recent Essential Health Benefits Bulletin
The Department of Health and Human Services released guidance on the Affordable Care Act's (ACA) Essential Health Benefit package (EHB) on Dec. 16. The EHB package will determine the health services, including the mental health (MH) and substance use disorder (SUD) services, that all health plans in the small group and individual markets will be required to cover beginning in 2014, as well as the minimum benefits for certain Medicaid beneficiaries. When the ACA is fully implemented, it is estimated that 70 million individuals will be enrolled in health coverage subject to the requirements of the EHB.
In its much-anticipated bulletin, HHS lays out a state-based process for defining the EHB based on the benefits currently provided by certain state and federal health plans. As required by the ACA, the guidance mandates that all EHB packages include coverage for mental health and substance use disorders -- and at parity. The guidance from HHS tells states how to develop the EHB, including which plans they use as benchmarks and how to supplement the required categories not provided by the benchmark plan.
Ensuring the EHB includes strong MH and SUD benefits has been a top priority for the Coalition for Whole Health, an umbrella of dozens of national MH and SUD prevention and treatment advocacy organizations co-chaired by Legal Action Center. In the weeks before the release of the EHB guidance, Legal Action Center, SAAS, and other CWH members attended HHS listening sessions and other meetings with key officials at HHS, SAMHSA, and ONDCP to advocate for strong benefits. LAC Director Paul Samuels was also given a private briefing by the assistant secretary for planning and evaluation and top White House officials. LAC and SAAS led the CWH in developing detailed comments in response to the proposal, which were signed by approximately 120 national, state, and local organizations and submitted to HHS on Jan. 31.
The comments advocated for HHS to provide aggressive oversight to ensure comprehensive coverage of each of the EHB's benefit categories, including the category requiring MH/SUD benefits. They also called on HHS to aggressively enforce MH/SUD parity compliance, to eliminate proposed state flexibility to benchmark EHB packages to potentially weaker small group health plans, to more clearly state the unique protections to the MH/SUD category provided by the parity law, and to ensure transparency and opportunities for provider and consumer input.
Updated Recommendations on Necessary MH/SUD Services for EHB packages
The Coalition for Whole Health also developed a shortened and updated "EHB Consensus Principles and Service Recommendations" paper, which describes specific MH and SUD benefit recommendations that all EHBs should include to ensure adequate coverage.
The recommendations outline necessary benefits across the full continuum of care for MH and SUD and include appropriate benefits for each of several of the EHB categories, including the MH/SUD disorder category and those requiring coverage for prescription drugs, rehabilitative and habilitative services, pediatric services, preventive and wellness services, and chronic disease management. The document also discusses how HHS and states should design and enforce the EHB in compliance with the ACA's requirements to extend the protections of the Mental Health Parity and Addiction Equity Act to all small group and individual plans.
New Resources in SAAS' Policy and Advocacy Toolkit
SAAS recently updated its Policy, Advocacy and Education Toolkit to include several new resources on essential health benefits, Medicaid, state-level work, parity implementation and enforcement, and more. Stay tuned for more updates of the toolkit, a comprehensive resource on healthcare reform implementation for both national and state-level advocates and providers.
Victory in FY 2012 Budget, With FY 2013 Process Gearing Up
On Dec. 23, the president signed into law the bill to fund the government through fiscal year 2012, which ends on Sept. 30, 2012. Despite a very challenging fiscal environment, the field was very effective in fighting off significant funding cuts to critically important SAMHSA programming. In particular, we were very pleased that Congress approved a $16 million increase to the Substance Abuse Prevention and Treatment Block Grant. Definitely a victory in this difficult funding environment!
President Obama released his FY 2013 budget recently, and SAAS and LAC will be working with our national partners to develop recommendations, to provide information to the field, and to advocate with Congress to fight for the highest possible funding for SAMHSA programming in FY 2013.
Work to Eliminate Legal and Policy Barriers for People in Recovery
Last fall, LAC developed a series of one-pagers on federal legal and policy barriers to education, employment, housing and public benefits for people with addiction and/or criminal histories. Over the winter we shared these one-pagers, including our recommendations to reduce these barriers, with the attorney general's Cabinet-level Reentry Council. LAC's one-pagers were then circulated to representatives from the involved federal agencies for response. Recently, LAC received a formal letter from the Reentry Council indicating that several of our recommendations were being implemented and that others were under consideration. We are excited to continue working with the Reentry Council to reduce barriers for our constituencies.
Fighting Proposals to Drug Test Unemployment Insurance Beneficiaries
LAC has worked with a number of allied state and national organizations over the winter to oppose new proposals to require drug testing of unemployment insurance beneficiaries. LAC recently worked with Congressional staff to respond at the federal level and developed a series of action alerts encouraging the field to weigh in about how these proposals are stigmatizing, not cost-effective, and unfairly penalize families and children who need assistance.
We were very pleased to see a strong showing of support through a letter authored by 14 U.S. senators, unequivocally stating that eligibility for unemployment benefits should not be predicated on passing a drug test; however, the tax-extender legislation signed into law last week allows states to drug test people applying for unemployment benefits who were terminated from their most recent job because of drug use, and people who work in industries that regularly conduct drug testing. As the focus of this activity turns to the states, LAC will continue working with allies around the country to oppose these harmful, ineffective policies.
LAC and SAAS, Around the Nation
LAC and SAAS have participated in several important meetings and conferences in DC and around the country this winter, including:
- Meetings with senior officials at HHS, ONDCP, SAMHSA, and the Department of Justice's Bureau of Justice Assistance;
- Presentations for national groups including TASC and Treatment Communities of America; and
- Presentations at state-wide conferences in Maryland, and Connecticut.
In addition to our continued advocacy in the coming weeks and months, SAAS and LAC are also preparing for the SAAS Winter Meeting in Washington in late February, which will include a Hill Day for the SAAS board members on March 1. Look forward to updates on these activities in the next National Advocacy Campaign Update.