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The Affordable Care Act (ACA) continues to shape and change the landscape of healthcare and healthcare reimbursement. It’s provisions have particularly large impacts on substance abuse treatment services, increasing the number of patients who have insurance coverage for treatment.
In the past, about 40 percent of nonprofit substance abuse treatment centers wouldn’t accept private insurance or Medicaid. Now that number is dropping thanks to two parts of the ACA.
Essential Health Benefits
The Affordable Care Act outlined essential benefits that every insurance plan must cover. In addition to annual appointments and maternity care, these essential benefits including mental health care and substance abuse treatment. By including substance abuse treatment in the list of essential benefits, the ACA gave millions of Americans coverage for these services almost overnight.
Mental Health Parity Laws
Mental health parity laws ensure that payors cover mental health services the same way they cover medical services. The ACA expanded parity laws to cover substance abuse treatment as well. Substance abuse treatment coverage can only be subjected to the same limitations and financial requirements as other medical services. If a service or claim is initially denied, you should always appeal to the insurance company, referencing parity laws. If that is denied, you should appeal to the state level.
Medicaid Expansion
Though Medicaid expansion was not required by the ACA, the majority of states have chosen to expand Medicaid, again providing coverage to millions more Americans. Many people experiencing substance abuse disorders now qualify for Medicaid for the first time ever.
In The Future…
With so many more Americans on Medicaid and enforceable reimbursement requirements thanks to parity laws, more substance abuse treatment centers should consider accepting this coverage. Although reimbursement rates are significantly lower, if you shift your business model appropriately, you can greatly expand your patient population.
This will also change what substance abuse treatment centers look like. High-end luxury treatment centers will have a more difficult time staying profitable as fewer patients will be forced to pay out of pocket. Instead, public funding will lead to more community-based models.
The ACA also provides funding for these community models or “medical homes.” It rewards integrated models of care that allow patients to receive all the care they need in one location. Instead of standalone treatment centers, this promotes coordination and integration of care and services among various treatment providers such as primary care and mental health services.
Programs may also become bigger as they adopt more of a health center model. Whereas in 2009, substance abuse treatment centers typically served just 15 to 30 patients at a time, integrated community programs are likely to serve higher numbers of patients at once.
All of these big changes are already underway and with further healthcare reform in the future, substance abuse treatment centers should be prepared to modify their business model.
No matter what the future holds, Datapro can help you manage payors, get days of treatment authorized and collect reimbursement for your insurance claims. Contact us today at 805-579-3537 or fill out our online form to learn how we can help your substance abuse treatment center keep up with the changes in healthcare.