Posted by Anna Strong on November 27th 2013
As we blogged about last week, we know that many Arkansans need better access to treatment for substance use disorders (addiction to alcohol or drugs). Thankfully, the law requires new individual-market plans to cover SUDs, a new benefit that was uncommon prior to the Affordable Care Act. In Arkansas, substance use disorders were primarily covered through treatment centers funded partially by block grants and funding streams that rarely included billing private insurance plans. Waiting lists for treatment have been the norm.
New plans sold in the Marketplace in Arkansas, including Private Option plans, are modeled off of Arkansas's benchmark plan. The benchmark plan was chosen in 2012, and it is required to offer the ACA's 10 essential health benefits, including treatment for SUDs. Arkansas's benchmark had to be supplemented in the areas of mental health and substance use disorder treatment in order to meet federal standards.
Now that the Marketplace is open for shopping, we have seen the details of what this coverage looks like. For an overview, you can look through this document that the AR Insurance Department created to analyze 2014 benefits for mental health, substance use disorder, and habilitative benefits that are provided by Blue Cross Blue Shield, QualChoice (QCA), and Ambetter (Celtic) plans.
In short, uninsured Arkansans who sign up for one of these private insurance plans will receive SUD benefits including the following:
- Inpatient SUD treatment, including partial hospitalization/halfway houses on most plans
- Outpatient treatment (clinic visits)
- Detoxification services
- Group therapy
While this is great news, we still have work to do in order to ensure an adequate network of providers are available for those seeking services. Two immediate barriers come to mind. First, the insurance companies require providers to be licensed and credentialed by certain accrediting bodies, and some SUD providers in Arkansas may not have achieved that yet. Second, because existing funding models did not require providers to bill insurance, they will have to get up to speed on billing and join the insurance carrier networks as soon as possible.
Many Arkansans will benefit from the new services that will be available for those with addiction to alcohol or drugs. Several SUD providers are at the ready with trained enrollment assisters who can help connect persons with addiction to coverage. Quapaw House, Harbor House, Southeast Behavioral Healthcare Systems, and the Mental Health Council of Arkansas are all ready to enroll the uninsured so families can get the treatment they need.