Our Position on Essential Health Benefits

Cumberland Heights Position Statement on The Essential Health Benefits to be Included in Insurance Policies Offered on The Nations Health Insurance Exchanges

Health Care Reform involves 2 important laws. The main piece of legislation is “The Patent Protection and Affordable Care Act” (otherwise known as “ObamaCare”). The other law is “The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008” (otherwise known as “Parity”). These 2 laws , while separate and distinct from each other, operate together to provide needed care for people, who prior to Health Care Reform, were unable to obtain treatment for the disease of alcohol and drug addiction. They could not get the treatment because, for one reason or another, they were without Insurance.

In January of 2013 the Federal Government will review each states plan to offer Insurance to those who do not have it. This “Readiness Review” will examine, among other things, the adequacy of the services being offered, not only for medical and surgical needs, but also treatment for “substance use disorders” (otherwise known as drug and alcohol rehabilitation). At that time Tennessee and the other 49 states will need to demonstrate the satisfactory operation of a “Health Insurance Exchange” in their respective states. Those Exchanges must offer Insurance Plans that provide for essential health services (otherwise known as “Essential Health Benefits”). Tennessee has chosen to develop their own Exchange and Essential Health Benefits package and the Department of Commerce and Insurance houses the team who will do this. Critical hearings are occurring this summer to determine what plan they will recommend to Governor Haslem this fall.

It is the position of The Cumberland Heights Foundation that the Essential Health Benefits should include the full range of treatment services available for the care of those who suffer from the disease of alcoholism and drug addiction. This means that patients who would otherwise not receive treatment will be cared for with a full “continuum of care” that begins with prevention, screening, and assessment and covers all levels of care necessary to address the patients needs, ranging from acute hospitalization services to residential rehabilitation as well as partial hospitalization, intensive outpatient, traditional outpatient services, and ongoing aftercare and case management services. In other words, those who suffer from the disease of alcoholism and addiction should have the same continuum of care afforded to other people with comparable medical needs resulting from acute and/or chronic disease states. That kind of coverage would be in keeping with the parity requirements of Health Care Reform.

It is further our position that the voices of those associated with the addiction treatment and recovery communities need to be heard. This includes former and current patients and families, providers and referring professionals, and other interested stakeholders. We encourage active participation in these hearings and plan to take an active role ourselves. Together we can positively impact the changes for recovery that will impact 640,000 Tennesseans with the disease of alcoholism and addiction as well as the 2,560,000 family members who must contend with the devastating consequences of this disease. This is the crucial spirit of the Parity act-to remove the discriminations in the care of people with mental health and addiction illnesses so that they receive the same care as those with physical illnesses. Recovery can happen!