Essential-benefits rule expands mental-health and substance-abuse coverage; Ky. needs more facilities to treat newly eligible

The Department of Health and Human Services has defined the 10 "essential health benefits" insurance plans must provide, and it included benefits for mental health and treatment of substance-abuse disorders..

Nearly 20 percent of Americans don't have access to mental-health services and over 30 percent have no coverage for substance-abuse treatment. This rule will expand mental health and substance-abuse treatment benefits to 62 million Americans, according to HHS.

Expanded coverage for mental health and substance abuse treatment programs in Kentucky could bring about a dramatic shift in the delivery of these services. There is already a shortage of treatment options and centers for Kentuckians, and those suffering from addiction have not had coverage for such treatment; the proposed rule will change that.

Recovery Kentucky, a public-private partnership with residential facilities, was created to help Kentuckians recover from substance abuse. It has 10 centers, in Campbellsville, Erlanger, Florence, Harlan, Henderson, Hopkinsville, Morehead, Owensboro, Paducah, and Richmond, according to the 2012 Justice & Public Safety Cabinet report, which included the map below. 

Health-insurance plans must cover the 10 essential benefits beginning in 2014, so the state must prepare for the newly insured in addition to newly covered services. The rule defines what must be covered in insurance plans and bans discrimination based on age or pre-existing conditions. Among the core package of items and services, known as “essential health benefits" are items and services in the following categories:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

States are given flexibility in implementing the federal health-care reform law with a benchmark approach. The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization plan serve as the “benchmark” plan for the Kentucky Health Benefit Exchange. HHS will review the recommendation and accept public comments prior to making a final decision. (Read more)

Anthem PPO plan chosen as 'benchmark' for state's Kentucky Health Benefit Exchange

The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization (PPO) plan serve as the “benchmark” plan for the Kentucky Health Benefit Exchange, as well as for plans offered outside the exchange. The statement issued by the department states that "Anthem PPO is the largest small group plan currently offered in Kentucky and includes coverage for all state mandates and the 10 essential health benefits, or categories of care, specified by the federal government under the Patient Protection and Affordable Care Act. The benchmark plan sets the minimum level of benefits offered in the individual and small group markets beginning Jan. 1, 2014."

According to the release, the Anthem PPO plan "is the most cost-effective of the 10 plans reviewed, will not create additional costs for the state and should not increase the price for those who have coverage today. Since the Anthem PPO plan does not offer the minimum requirements for pediatric vision and dental services, Kentucky has recommended that the benefits in the Kentucky Children’s Health Insurance Program (KCHIP) be substituted in the benchmark plan."

Some background, also provided by the Dept. of Insurance: One of the goals of the Affordable Care Act is to ensure that Americans will have access to quality, affordable health insurance. To achieve this goal, the law ensures health plans offered in the individual and small group markets offer a comprehensive package of items and services, known as Essential Health Benefits. The act provides that the EHBs include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. For more on Essential Health Benefits, go here.

The U.S. Department of Health and Human Services will review the Athem recommendation and accept public comments prior to making a final decision on the matter.

Flexibility Act would give states more Medicaid authority, but it could mean that fewer children would have health coverage

MEDICAID PERCENTAGE OF TOTAL STATE SPENDING

Children's advocates are concerned the proposed State Flexibility Act would result in more children living without health insurance in Kentucky.

The act "would repeal protections put in place for states to maintain current eligibility and enrollment requirements for Medicaid and the Children's Health Insurance Program, known in Kentucky as K-CHIP," Renee Shaw of the Public News Service reports.

The goal of the act, its sponsors say, is to give states more flexibility so they can balance their own budgets. "The onerous federal mandates on states today make it especially challenging for states to solve the unprecedented budget crises, and governors have asked Washington for relief from these excessive constraints," the act reads. In Kentucky, there is a a projected budget shortfall of $780 million for Fiscal 2012, $166.5 million of which is due to a gap in Medicaid funding.

But Lacey McNary, deputy director of Kentucky Youth Advocates, say the move would only further burden families. "Children who in Kentucky are up to 200 percent of the poverty level can enroll, and they're eligible for K-CHIP," she said. "In order to save some money, the state could say, 'We're only going to cover kids up to 150 percent of poverty' — thus, covering less children and saving money."

Estimates show almost half of Kentucky's children have government-supported health insurance. About 60,000 kids are enrolled in K-CHIP every month and another 386,000 Kentuckians are enrolled in Medicaid, which serves low-income and disabled Americans, including children. "It's been proven that K-CHIP is a very successful program to get kids covered," McNary said. "This bill is a permission slip for governors to reduce coverage for kids, to balance the budget."

If the bill passes, about 14 million children nationwide could be at risk for losing their health insurance, Shaw reports. (Read more)

More Kentucky children are insured under KCHIP, Medicaid; groups commend effort, ask for improvements

In the two years since the national Children's Health Insurance Program was reauthorized, about 51,700 children have been enrolled in Kentucky CHIP and Medicaid. Three advocacy groups -- Covering Kentucky Kids and Families, Kentucky Youth Advocates and Kentucky Voices for Health -- commended that effort and asked for greater efficiency in KCHIP.

"The number of uninsured children in Kentucky has dropped despite the loss of jobs and employer-sponsored coverage in our state," the three groups said in a statement Feb. 3. They asked that KCHIP be made more efficient by "allowing continuous eligibility, matching application information with existing databases, and developing web-based applications."

In Kentucky, kids up to age 19, with family incomes up to 200 percent of the federal poverty level, are eligible for KCHIP. That equates to an annual earnings of $44,000 for a family of four. (Read more)