|August 04, 2011||
Health Reform Law, Other Changes Could Transform Public Addiction Treatment In The United States
Analysis published in Health Affairs is one of several articles in the August 2011 issue that focus on the problem of substance abuse
Bethesda, MD -- Provisions of the Affordable Care Act and other recent legislative changes will transform public substance abuse treatment in the United States, substantially increasing the funding, expanding access to care, and better integrating it with other health services. That's the conclusion of an article by Jeffrey A. Buck, senior advisor for behavioral health in the Center for Strategic Planning, Centers for Medicare and Medicaid Services, in the August 2011 issue of Health Affairs.
Buck's article is among a cluster of articles in the issue that focus on substance abuse. Also in the issue:
Public Substance Abuse Treatment
"Transformation of the public substance abuse treatment system was never one of the explicit goals in health care reform," writes Buck. "But policies expanding health insurance coverage and providing substance abuse treatment benefits at parity with medical and surgical benefits are likely to have that effect." The result, he concludes, "should be a system of care that significantly improves the treatment of substance abuse disorders in the United States."
Under the Affordable Care Act, the broad expansion of Medicaid in 2014 is expected to double the number of non-elderly adults with behavioral health disorders who will be covered by the program. It's likely that many of these newly eligible Medicaid beneficiaries will have some level of mental health and substance abuse treatment coverage for the first time. What's more, these services must be provided on parity with other medical benefits. In addition, the federal government will fully finance coverage for newly eligible beneficiaries through 2016, after which its share will decline only slightly.
Many of those newly eligible are likely to have substance abuse disorders, many of them severe. The current public treatment system, which comprises mainly small, stand-alone, non-profit or government-operated facilities with little to no competition and severe funding and infrastructure restraints, will need to adapt to these new demands.
Because there will be a fundamental shift in public funding for substance abuse treatment from a patchwork of state and local grants and contracts toward federally supported health insurance, health reform will provide incentives to modernize the delivery system for addiction treatment and provide better care based on best practices and evidence.
Buck predicts that, over the next 10 years, the system for delivering substance abuse treatment will become increasingly professionalized, less residential, and more outpatient-focused.
Non-specialty providers, in particular federally qualified health centers, which will receive a large boost in federal funding, will probably assume a greater role in substance abuse treatment, as will physicians, psychologists, nurse practitioners, and other health professionals. Health information technology systems -- currently lacking among many substance abuse treatment providers -- will become more prominent.
In addition, treatment will become more medically oriented and less reliant on education and psychosocial support provided by peer or lay counselors, services that generally do not qualify for Medicaid reimbursement. Treatment based on medications such as methadone and buprenorphine will likely increase. New incentives under health reform will also encourage the use of evidence-based practices and the integration of substance abuse treatment with general medical treatment, Buck notes.
Substance Abuse and HIV
Overcoming Opioid Abuse and Misuse
Substance Abuse Treatment in Medicaid
|About Health Affairs|
Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at www.healthaffairs.org. You can also find the journal on Facebook and Twitter and download Narrative Matters on iTunes. Address inquiries to Sue Ducat at (301) 841-9962 or firstname.lastname@example.org