The Affordable Care Act is potentially changing how treatment for addiction will be funded or reimbursed. For those of us that have spent decades in the treatment field, we understand that instead of looking at this as yet another change, it is better to embrace the act as an evolution of our field and profession.
The age old saying of, “be careful what you pray for, you may get it,” yet once again is becoming a reality. For me personally, I have prayed for greater understanding and more research about the disease.
We have evolved from using the words “substance abuse,” “chemical dependency,” “drug addiction,” and “alcoholism,” to now what is known as “substance use disorder.”
As treatment facilities, we are moving from ICD-9 to ICD-10 codes. We are evolving from an acute model of care to a chronic model of care for what is now known as a chronic brain disorder. We have gone from the Hughes Act in the 1970’s which mandated insurances to begin funding care for 30 days of coverage, to the onslaught of managed care in the 1990’s where many providers did not survive the economic downfall. We have weathered the financial crisis of 2008, to the Parity Act of today. The concern at first was whether or not addiction would be included in the mental health parity bill at all, and whether residential care would be included in the Affordable Care Act. At present, the Affordable Care Act has gone forward with parity having been embedded in it and residential care has become a large component.
We are concerned now as providers with understanding the 10 essential benefits of the Affordable Care Act. The federal government is promoting all of this and demanding that it be held up on a state by state basis.
So what does this really mean to all of us? What does it mean to management? What does it mean to billing and collections? What does it mean to clinical care? I choose to see this as an opportunity for us to yet once again improve the care that we provide to those desperately needing our services. By embracing this opportunity we will be stretching our abilities on how to best manage addiction treatment programs. We will need to ask the question of how to meet the challenge of not having enough employees to serve the many that will begin coming forward for services because the once un-insured are now insured. We can take this as an opportunity to engage in discussion in a more meaningful way with physicians and broader health care providers about what substance use disorders are.
You might be asking yourself: what are the 10 essential benefits and how will we be impacted as treatment facilities?
Under the Affordable Care Act, the following 10 essential health benefits are included in all service plans: