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Issues

Role and Value of BHOs

Specialty behavioral health organizations (BHOs) provide mental health and substance use disorder treatment to approximately 171 million individuals, including dual eligible beneficiaries. In the past 25 years, BHOs have established a record of success increasing quality and access, managing costs, coordinating care and promoting wellness for people with behavioral health disorders.

BHOs have developed effective strategies for reaching out to and effectively serving individuals with behavioral health disorders. No other segment of the health care industry has the unique experience and specialization of BHOs across both the public and private health insurance market place.

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Medicaid, Medicare, and Dual Eligibles

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Nearly nine million low-income seniors and young people with disabilities are considered “dual eligible,” meaning that they are enrolled in both Medicare and Medicaid. Dual eligibles, as they are known, are among the sickest people covered by Medicare and Medicaid. Approximately 60 percent of them have a severe cognitive and/or mental disability and they often require specialized services tailored to their individual condition and needs. If these services are not provided appropriately, the end result will be sicker patients and higher costs.

As federal and state policymakers increasingly look to reduce costs, improve health outcomes and coordinate care, services provided to dual eligibles and the Medicaid population will be of critical importance. BHOs specialize in providing innovative, coordinated and cost-effective care that is focused on improving the quality of life for individuals living with a mental health issue and/or substance use disorder. With proven experience providing quality care, BHOs will be an essential part of both Medicaid expansion under health care reform implementation and efforts to more effectively serve dual-eligible beneficiaries.

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Health Care Reform Implementation and Other Related Issues

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Former U.S. Surgeon General Satcher said, “There is no health without mental health. ” To be truly effective, health care reform must take into account the enormous costs – both financial and social – of untreated mental illness and substance use disorders and must implement strategies to make behavioral health an integral and vital component of overall health.

ABHW advocates for a reformed health care system that encourages maximum collaboration and care management by bridging the current gaps between behavioral health care and physical medical care. If done right, health care reform will result in more and better behavioral health care for a greater number of people.

ABHW closely monitors and provides input on a variety of topics related to the Affordable Care Act (ACA), and other related issues, including the definition of the Essential Health Benefit, the establishment of health insurance exchanges as well as some of the more administrative requirements of the ACA, for example grievance and appeals, medical loss ratio and summary of benefits and coverage.

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Parity Implementation

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Throughout our history, ABHW has been a strong advocate for parity legislation, including serving as an original member of the Coalition for Fairness in Mental Illness Coverage, with Pamela Greenberg as chair of the coalition for four years. The coalition was formed in the mid-1990’s to win equitable mental health coverage through the enactment of federal mental health parity legislation. Members included: American Hospital Association, American Medical Association, American Psychiatric Association, American Psychological Association, Association for Behavioral Health and Wellness, Federation of American Hospitals, Mental Health America, National Alliance on Mental Illness, National Association of Psychiatric Health Systems.

ABHW and its member companies have long believed that it was important for financial and treatment coverage in health insurance policies to be equal between behavioral health and physical medical health care. The Mental Health Parity Addiction Equity Act, passed in 2008, requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits. (MHPAEA supplements prior provisions under the Mental Health Parity Act of 1996 MHPA), which required parity with respect to aggregate lifetime and annual dollar limits for mental health benefits. AMBHA/ABHW supported the passage of MHPA as well as MHPAEA.

Although ABHW member companies have some concerns with the breadth and impact of the MHPAEA interim final rule issued on February 2, 2010, we remain committed to the goal of mental health parity and continue to play an important role in the implementation of the historic Wellstone-Domenici law.  

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ABHW

Perspectives

HEALTHCARE INTEGRATION IN THE ERA OF THE AFFORDABLE CARE ACT

Changes are occurring across the healthcare landscape, with a significant focus on integration of behavioral and physical health. This paper is intended to help inform these efforts by focusing on the long history Association for Behavioral Health and Wellness...

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NEW

ABHW

Publications

ABHW Press Release to House Leadership Over AHCA Concerns (March 23, 2017)

ABHW Comment Letter to House Leadership on ACHA (March 22, 2017)

ABHW Press Release on Confirmation of New HHS Secretary Price and CMS Administrator Verma (March 17, 2017)

ABHW Comment Letter to Rep Murphy (March 10, 2017)

ABHW Comment Letter on Market Stabilization Prop Rule (March 8, 2017)

ABHW Press Release on SNPRM Part 2 Comment Letter (February 17, 2017)

ABHW SNPRM Comment Letter to SAMHSA on Confidentiality (February 17, 2017)

ABHW Summary of 42 CFR Part 2 Final Rule and SNPRM (February 1, 2017)

ABHW Paper - Behavioral Health Organizations Current and Future Approaches to Addressing the U.S. Opioid Crisis (May 2016)

ABHW Comments on the notice of proposed rulemaking on Medication Assisted Treatment for Opioid Use Disorders (May 27, 2016)

ABHW and Diverse List of Health Care Stakeholders Letter to House Leadership calling attention to the importance of amending 42 CFR Part 2 (May 10, 2016)

ABHW Interview on 42 CFR Part 2 (April 27, 2016)

ABHW Editorial on 42 CFR Part 2 (April 11, 2016)

ABHW Press Release: ABHW and Diverse List of Health Care Stakeholders want HIPAA Standard to Apply to Substance Use Records (April 11, 2016)

ABHW and Diverse List of Health Care Stakeholders Comments: on the notice of proposed rulemaking on the Confidentiality of Substance Use Disorder Patient Records, 42 CFR Part 2 (April 11, 2016)

ABHW Comments: on the notice of proposed rulemaking on the Confidentiality of Substance Use Disorder Patient Records, 42 CFR Part 2 (April 11, 2016)

ABHW Press Release: ABHW Supports Changes to Outdated Substance Use Disorder Privacy Regulation (February 5, 2016)

ABHW Paper: on 42 CFR Part 2 - Now is the Time to Strengthen Protection of Substance Use Records by Revisiting the Substance Use Privacy Law (December 21, 2015)

ABHW Press Release: on 42 CFR Part 2 - All ABHW Wants for Christmas are Changes to the Substance Use Privacy Law (December 21, 2015)

ABHW Paper: on Healthcare Integration in the Era of the Affordable Care Act (August 5, 2015)

ABHW Press Release: ABHW Released Report Demonstrating Critical Role Managed Behavioral Healthcare Organizations Play in the Integration of Behavioral and Physical Health (August 5, 2015)

ABHW Press Release: on the Institute of Medicine (IOM) report on Psychosocial Interventions for Mental and Substance Use Disorders (July 14, 2015)

ABHW Comments on SAMHSA’s Peer Core Competencies: ABHW is pleased to see a comprehensive list of essential core competencies required by peer providers. (May 21, 2015)

ABHW Press Statement: ABHW Mourns Loss of Robin Williams (August 12, 2014)

Stamp Out Stigma highlighted in Behavioral Healthcare, MBHOs Launch Anti-Stigma Campaign for MI and SUD (May 22, 2014)

ABHW Press Release: ABHW Applauds Reps. Peters and Miller for Introducing National Mental Health No Stigma Week Resolution (May 14, 2014)

ABHW Press Release: ABHW Launches Stamp Out Stigma Campaign to Reach 1 Million People in 2014 (April 2, 2014)

Final Parity Rule Provides New Guidance for ABHW Members – The Association for Behavioral Health and Wellness (ABHW) issued the following statement today in response to the release of the final Mental Health Parity and Addiction Equity Act (MHPAEA) regulations this morning. (November 8, 2013)

ABHW letter to the Senate Finance Committee in response to the Committee’s request for information from the mental health community on how to improve the mental health system in the United States (September 30, 2013)

ABHW Press Release: ABHW President and CEO Participates in Historic White House Conference on Mental Health, Applauds National Dialogue (June 3, 2013)


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