Department of Health Policy and Management, University of Pittsburgh, 130 De Soto St., Crabtree A612, Pittsburgh, PA 15261, USA.
Psychiatr Serv. 2010 Nov;61(11):1081-6. doi: 10.1176/ps.2010.61.11.1081.
The Patient Protection and Affordable Care Act will expand insurance coverage to millions of Americans with mental disorders. One particularly important implementation issue is the scope of mental health and substance abuse services under expanded health insurance coverage. This article examines current public and commercial insurance coverage of the range of services used by individuals with mental illnesses and substance use disorders and assesses the implications of newly mandated standards for benefit packages offered by public and private plans. The authors note that many services needed by individuals with mental or substance use disorders fall outside the scope of benefits currently covered by a typical private insurance plan. Compared with other insurers, Medicaid currently covers a broader range of behavioral health services; however, individuals moving into Medicaid under new eligibility pathways will receive "benchmark" or "benchmark-equivalent" coverage rather than full Medicaid benefits. If behavioral health benefits are set at those currently available in typical private plans or in benchmark coverage, some newly insured individuals with mental illnesses or substance use disorders who are covered by private plans or Medicaid expansions are still likely to face gaps in covered services. Policy makers have several options for addressing these likely gaps in coverage, including requiring states to maintain coverage of some support services, including certain behavioral health services in the "essential benefits package," and expanding eligibility for full Medicaid benefits.
《患者保护与平价医疗法案》将为数百万患有精神疾病的美国人扩大保险范围。一个特别重要的实施问题是扩大医疗保险覆盖范围下的心理健康和物质滥用服务的范围。本文考察了当前公共和商业保险对精神疾病和物质使用障碍患者使用的一系列服务的覆盖范围，并评估了新规定的福利套餐对公共和私人计划的影响。作者指出，许多患有精神或物质使用障碍的人需要的服务不在典型私人保险计划涵盖的福利范围内。与其他保险公司相比，医疗补助计划目前涵盖了更广泛的行为健康服务；然而，根据新的资格途径进入医疗补助计划的个人将获得“基准”或“基准等效”覆盖，而不是全额医疗补助福利。如果行为健康福利设定为典型私人计划或基准覆盖范围内目前提供的福利，一些新获得私人计划或医疗补助扩大覆盖的精神疾病或物质使用障碍患者仍可能面临服务覆盖范围的差距。政策制定者有几种选择来解决这些可能存在的覆盖差距，包括要求各州维持某些支持性服务的覆盖范围，包括“基本福利包”中的某些行为健康服务，以及扩大全额医疗补助福利的资格。
