Health Care Reform Propels Shift in Mental Health Business Model

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By now, many patients may have noticed a change in their doctors' offices. Perhaps you've been asked to sign new confidentiality agreements, or maybe your doctor moved into a larger office with more providers. The phenomenon of large provider groups gobbling up small health care provider practices has arrived, and it's having an especially significant effect on mental health providers. 

Psychiatrists and psychologists are feeling a loss of autonomy, as their patients and schedules are now being chosen and managed by larger institutions.  In some cases, these providers are also taking significant cuts to their paychecks.  Blue Shield of California, for instance, recently asked psychologists on their plans to accept anywhere from a 10- to 30- perfect discount for patients who will buy health plans through Covered California. (Kaiser Health News, 10/24/13.)

As more and more patients expect their mental health care to be covered by insurance, there may soon be a trend away from smaller practices who may not accept as many insurance plans. As patients

But the shift from solo/small practices toward large medical groups isn't all bad, especially not for patients. 

For patients, it may mean lower prices, especially when for mental health services. Where as patients might have paid $150 out of pocket for a therapy session, those same sessions may now be covered by insurance via the 2008 mental health parity law.  Mental health parity requires private and public insurers to cover mental health needs, if at all, just as they do physical health conditions, such as similar co-pays for for physical and mental health services.

In addition, quality of care has great potential to increase as a result of this shift. For example, mental health providers are becoming increasingly integrated into multidisciplinary practice and health clinics.  When a psychologist or psychiatric nurse practitioner sits alongside internists and pediatricians, a more holistic approach to patient care develops that can cut back on unnecessary tests and treatments, potentially saving money for institutions, as well as patients.

UPS Drops Spousal Healthcare Coverage, Cites ACA

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The United Parcel Service (UPS) announced plans to drop 15,000 employee spouses from its healthcare plan.  UPS said "rising medical costs, 'combined with the costs associated with the Affordable Care Act, have made it increasingly difficult to provide the same level of health care benefits to our employees at an affordable cost.'" (Washington Times, 8/22.)  UPS spokesman Andy McGowan says the company expects the move to save $60 million a year.

CNBC notes that according to a recent Towers Watson survey, "mid- to large-sized companies overwhelmingly expect health-care costs to increase under Obamacare--and most are eyeing possible changes to their health insurance offerings because of a looming excise tax for pricier plans under the health-care reform law."  In fact, the survey revealed that 40 percent of the 400+ companies surveyed said they will be changing the design of their insurance plans in 2014.  Nearly 60 percent of those companies see the state health insurance Marketplaces as a possible way to control costs by shifting the work of insuring their employees onto the Marketplaces in the future.

In response to the UPS announcement, FedEx Corp. "isn't travelling the same route as delivery competitor UPS when it comes to trying to cut out health benefits for spouses and other family members. (Pittsburgh Business Times, 8/22.)

New ACA Roll-Outs: Abortion Coverage on the Hill, Medicare House Calls & Colorado Marketplace Rates

As full implementation of the Affordable Care Act approaches, many new programs and state Marketplaces continue to roll out daily.

Taxpayer-Funded Abortion Coverage for Congress

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An amendment by Iowa Republican Senator Charles E. Grassley requires lawmakers and their staff to obtain coverage through the same insurance Marketplaces that many uninsured Americans will use.  However, many abortion opponents, including Sen. Grassley, worry that this will give members of Congress access to abortion coverage.  Currently, that benefit is denied to members of Congress and all federal employees who receive health insurance through a federal government plan.  Rep. Christopher H. Smith (R-NJ), who authored the abortion-funding ban for federal employee plans, says that requiring Congress to purchase health insurance in the Marketplace would be "a radical deviation and departure from current federal law."


Under the Affordable Care Act, every state must have at least one plan that does not cover abortion.  But the decision as to whether a state must have one plan that provides abortion coverage is left completely up to the individual state. So far, 23 states have barred or restricted abortion coverage in Marketplace plans; 27 states, and the D.C., have no such restrictions.

Medicare Doctors Make House Calls

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Under an ACA program called "Independence at Home," the Centers for Medicare and Medicaid Services contracted with 20 providers or provider groups nationwide to incentivize primary care providers who accept Medicare payments to make house calls to "medically complex patients."  The goal of the program is to improve quality of care and prevent future, more expensive treatments by encouraging doctors to invest in their Medicare patients up front.  The ACA authorizes expanding the program if this goal is met -- if quality of care improves at the same or lower cost and with the same or better outcomes.

Colorado Releases Marketplace Insurance Rates

Colorado's Division of Insurance released next year's rates under the ACA.  Colorado's Marketplace will house a whopping 18 different insurers providing 541 different plans for both individuals and small businesses.  The Denver Business Journal reported that these rates prove Colorado will not experience "rate shock," meaning consumers will likely not see higher sticker prices on the state's Marketplace than they do for presently available insurance options.  Like many states, the rates will depend on the region in Colorado where the customer lives.

How Will Health Insurance Marketplaces Verify Income for Premium Subsidies?

Many individuals and small businesses will be eligible for premium subsidies for health insurance purchased through Obamacare's online Marketplaces, starting October 1.  As part of the eligibility process, Marketplaces must verify the income of consumers by using tax filing and Social Security data  to verify household income.

Here's how it will work. When an individual applies for health insurance through an online Marketplace, she will be asked to verify her projected household income.  That inputted data will then be verified with information available through the Internal Revenue Service (IRS) and Social Security Administration (SSA).  If the data submitted by the individual cannot be verified through these avenues, additional wage information will be compared from employers via Equifax, if available.  

State-based Marketplaces, meaning states that have set up and will independently administer their own health insurance Marketplace, “may choose to request additional documentation from a statistically-significant sample of the group of individuals in only one specific situation: when the Marketplace has IRS data, the application filer inputs projected annual household income that is more than ten percent below IRS and SSA data, Equifax data is unavailable, and the individual does not provide a reasonable explanation for the inconsistency between the attestation and IRS and SSA data.” (CMS FAQs.)  

Federally-facilitated Marketplaces however, (that is, Marketplaces that will be run by the federal government because the state either refused to do it themselves, or elected to have a federally-run Marketplace) will require 100% of applicants applying for premium subsidies to provide additional documentation "with no exceptions."

Create Your Personal "Obamacare" Account

Online Profile
HHS Secretary Sebelius announced Monday that consumers can now open personal healthcare accounts online at healthcare.gov in anticipation of the innaugural October 1 open enrollment for plans offered through state health insurance exchanges.  Starting in September, you can begin comparing plans side-by-side through the online marketplace in your state.

The new personal account information is available only in English, for the time being. But HHS stated that personal account will be coming soon to the Spanish-language marketplace, at cuidadodesalud.gov.

The new online insurance marketplaces will be geared to people who don't have coverage through their jobs, most of whom will be eligible for tax credits to help pay their premiums. Insurance benefits take effect Jan. 1. That's also when the law will require most Americans to have health insurance or face fines. In return, insurers will be barred from turning away people with medical problems, often referred to as preexisting conditions. The administration hopes to sign up at least 7 million uninsured people next year.

Marketplace Checklist
In addition to creating your online profile, you can also answer a few simple questions about your current health insurance status in order to generate a personalized "Marketplace Checklist."  This checklist will provide you with information about how to get ready for open enrollment and allow you to gather all the necessary information to hit the ground running in October.

Still don't understand what a health insurance exchange is? Don't worry! The government has also launched training videos and infographics to further help Americans understand the exchanges.

Individual Marketplace

Small Business Call Center
HHS also launched a special call center on Monday for small businesses, at 800-706-7893.  Small businesses will have access to a separate marketplace, and may also be eligible for tax credits.

Learn more about how your small business can provide coverage through Obamacare by watching this short video!

Small Business Marketplace