ࡱ> ]_\'` $bjbj{P{P 7b::HHH8T||"rtttttt$ h=#F666r6r666p LH&606#*#6#66^  ISSUEMental Health Provision Mental Health/Substance Abuse Benefits InclusionIncludes mental health and substance abuse disorder services, including behavioral health treatment, as essential benefits under the exchange plans. (Sec. 1302(b)(1)(E)) Does not have an employer mandate; all mental health and substance abuse benefits are only available in exchange plans and Medicaid. ParityQualified health plans offered by the state exchanges will have to provide MH/SA coverage that meets the requirements of the federal parity law. (Sec. 1311(j)) As of enactment, the federal parity law applies to the individual and small group market. (Sec. 1562(c)(4)) Extends mental health and substance abuse parity to Medicaid expansion populations. (Sec. 2001(c)(6)) Employer Grandfather ProvisionsPermits employers to continue to offer existing benefit plans indefinitely which may or may not include mental health or substance use benefits or offer only a limited benefit. (Sec. 1251, as amended by Sec. 10103) Medicaid ExpansionBeginning in 2014, or sooner at state option, the law requires states to expand Medicaid to certain individuals who are under age 65 with income up to 133% of the federal poverty level (FPL). Newly eligible individuals will receive either benchmark or benchmark-equivalent coverage consistent with the requirements of SSA Sec. 1937. The law also modifies income counting rules when determining Medicaid eligibility for certain populations. From 2014 to 2016, the federal government will cover 100% of the Medicaid costs of these newly eligible individuals, with the percentage dropping to 90% (with states covering the difference) by 2020. (Sec. 2001 as amended by Sec. 10201; P.L. 111-152: Secs.1004 & 1201) Medicaid Health HomeCreates a new Medicaid state plan option under which certain Medicaid enrollees with chronic conditions could designate a health home, and specifically requires states to consult and coordinate, as appropriate, with SAMHSA on the prevention and treatment of MH/SA for those with chronic illnesses. (Sec. 2703)  Benefit Design Qualified health plans offered by the state exchanges will provide 4 levels of benefits (Bronze, Silver, Gold and Platinum) in the individual and small group markets. The differences among levels are based on different cost sharing, not differences in covered benefits. However, exchanges may allow a young invincible plan to be offered in the individual market. This plan would provide catastrophic coverage for (1) persons under 30 years of age or (2) persons given a hardship waiver or are exempt from the individual mandate because no affordable coverage is available to them. Typically, segmenting risk leads to larger premiums for those in risk pools with less-healthy enrollees, however the law also requires insurers to consider all enrollees in all plans in the individual (or small group) market as members of one risk pool. It is unclear what impact these provisions will have on premiums. (Secs. 1302 and 1312) 340B Drug Discount ProgramExpands the list of covered entities eligible for PHSA Sec. 340B discounts for outpatient drugs (including psychotherapeutic drugs) to include the following: (1) certain childrens and free-standing cancer hospitals excluded from the Medicare prospective payment system, (2) critical access hospitals, and (3) certain rural referral centers and critical access hospitals. (Sec. 7101) Clinical Prevention ServicesProvides new coverage mandates for private insurance; requires coverage of an annual wellness exam under Medicare; waives cost sharing for most Medicare covered preventive services; and provides an enhanced federal match for states that cover preventive services, without cost-sharing, for eligible adults under Medicaid. In some cases, services that are recommended by the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices must be covered. (Sec. 1001, 1302, 4103, 4104, 4106) Workforce: Mental and Behavioral Health Education and Training GrantsAuthorizes a grant program to support the recruitment and education of students in various mental and behavioral fields. (Sec. 5306) Community-based Mental Health Centers: Care CoordinationAuthorizes a grant program to fund demonstration projects for providing coordinated care to individuals with mental illness and co-occurring primary care conditions and chronic diseases. Primary and specialty care services would be co-located in community-based mental health settings. (Sec. 5604) Workforce: Primary Care Provider Extension ProgramAuthorizes a grant program to fund local primary care extension agencies to support and educate primary care providers about preventive medicine, chronic disease management, and mental health services. (Sec. 5404)  Workforce: Public Health Service Track Provides funding to establish a science track at academic sites selected by the Secretary to award degrees that emphasize team-based service, public health, epidemiology, and emergency preparedness and response. The track would be organized so as to graduate, annually, specified minimum numbers of students of medicine, dentistry, nursing, public health, and behavioral and mental health. (Sec. 5315)Insurance ReformsIncludes significant insurance reforms that will impact persons with medical conditions, including no coverage exclusions for pre-existing conditions, guaranteed renewability of coverage, basing premiums on a few factors (not to include health), and regarding eligibility for coverage, prohibiting discrimination on health factors, including receipt of health care, medical history, disability, and other factors. (Sec. 1201, as amended by Sec. 10103)Institutions for Mental Disease (IMD): Medicaid Emergency Psychiatric DemonstrationEstablishes a demonstration program under which eligible states will reimburse certain IMDs that are not publicly owned or operated for medical assistance to individuals: (1) aged 21 through 64; (2) eligible for medical assistance under such plan; and (3) requiring such medical assistance to stabilize a psychiatric emergency medical condition, as evidenced by the expression of suicidal or homicidal thoughts or gestures determined dangerous to the individual or others. (Sec. 2707)Support, Education, and Research for Postpartum DepressionEncourages more specified types of researchincluding epidemiology, improved screening and diagnosis, clinical research, and public educationon the causes of and treatments for postpartum depression. Authorizes a new grant program to provide health and support services to individuals with postpartum depression and their families. (Sec. 2952)Medicare: Physician Fee Schedule Mental Health Add-onThe 5% increase in payments for certain Medicare mental health services, which ended on December 31, 2009, is extended through December 31, 2011. (Sec. 3107)Medicare and Medicaid Nursing Facilities: Dementia and Abuse Prevention TrainingExpands nurse staff training requirements to include dementia training and patient abuse prevention training. (Sec. 6121)     PAGE  PAGE 1 Mental Health Provisions within the Healthcare Reform Bill Report provided by CRS per the request of the Congressional Mental Health Caucus Congresswoman Grace F. 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