Mental Health

as an essential benefit under Health Care Reform

Every qualified health plan (ACA/Health Care Reform ObamaCare compliant-meeting the 10 essential benefits) must provide parity the same benefits – coverage for mental health and substance use services, the same as for physical illness resulting in no added treatment limits and no extra costs.

More than 43 million Americans suffer from depression, anxiety, and other mental health conditions, according to the most recent federal data. But more than half the people who felt like they needed help last year, never got it. Even people who had insurance complained of barriers to care.  Narrow Provider Lists? Some said they still couldn’t afford it; some were embarrassed to ask for help.

Others just couldn’t get through the red tape.  See the FAQ button below or our appeals webpage.  We can help you with “Red Tape.” 

Our webpage on when services & treatment are considered  Medically  Necessary

Clinical UM – Utilization Management Bulletins

Behavioral Health
 
  • CG-BEH-03 Psychiatric Disorder Treatment
  • CG-BEH-04 Substance-Related and Addictive Disorder Treatment
  • Medi Cal Addiction Treatment Moves into the Main Stream
  • CG-BEH-05 Eating and Feeding Disorder Treatment
  • CG-BEH-07 Psychological Testing
  • CG-BEH-08 Employee Assistance Program Outpatient Treatment
  • CG-BEH-09 Assertive Community Treatment (ACT)
  • CG-BEH-10 Basic Skills Training/Social Skills Training
  • CG-BEH-11 Mental Health Support Services
  • CG-BEH-12 Psychosocial Rehabilitation Services
  • CG-BEH-13 Targeted Case Management (TCM)

Specimen Policy

Mental Health Page 86

Specimen Policy - Mental Health Page 86

Technical Links & Resources

42  USC  18022 (E) Mental health and substance use disorder services, including behavioral health treatment.

CFR 156.115 (a) (3), – Provisions of Essential Health Benefits

Federal Mental Health Parity

2008 Final Rules (direct link broke – use DOL’s search feature)

§146.136   Parity in mental health and substance use disorder benefits.

Medicare & You - Mental Health

Medicare & Mental Illness # 10184   

Medicare & Mental Illness # 10184

Our Webpage on Medicare & Mental Health

Compliance Assistance Guide from DOL.Gov Health Benefits under Federal Law

Mental Health Videos

You Tube Videos

 

8 comments on “Mental Health – An Essential Benefit

  1. Editorial
    Improved Mental Health before forcing it on people

    The real problem, the audit found, is not the patients’ right to self-determination, but the failure of the state and counties to provide sufficient ongoing care and housing after the forced treatment ends. Without those services, patients end up in a dismal and destructive cycle — careening from a 72-hour “5150” hold to the street, to another mental health crisis that endangers themselves or others, and back to another three-day hold. Each new breakdown can cause further lasting damage.

    https://www.latimes.com/opinion/story/2020-08-07/improve-mental-health-care-before-forcing-it-on-people

  2. Hey Editors,

    My name is Martin and I am the CEO & Co-Founder of Cleverism.com — a leading educational website that helps people actually get their dream job (we write super actionable and helpful career guides :-).

    I stumbled upon your post on “Five stages of dealing with grief” and I thought it was very insightful.

    Over the last 2 weeks I wrote probably the most actionable and helpful guide on everything people ever wanted to know about Kubler-Ross change curve, Relevance and applications of Kubler-Ross Change Curve in Business etc.
    Change is an inevitable part and truth of life, and there is no running away from it. If change is well planned and formulated, it can produce positive results but even in spite of planning, change is hard to incorporate, accept and appreciate. This article shall throw light on the Kubler-Ross Change Curve that is the most reliable tool to understand change. The Kubler-Ross Change Curve can be effectively used by business leaders to help their workforce adapt to change and move towards success.

    In this article, we explore 1) what is Kubler-Ross Model, 2) the applications of the Kubler-Ross Change Curve, and 3) variations of change curve concepts. Any chance you’d include our actionable guide on “Kubler-Ross Change Curve” (https://www.cleverism.com/) in your awesome article (https://mentalhealth.healthreformquotes.com/mental-health/resources-mental-health/blame-fault-scapegoated/)?

    Have a lovely day and keep up the good work,

    Martin
    CEO Cleverism

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