Congress passed the Mental Health Parity Act in 2008 requiring health insurers to provide coverage for mental health and substance use disorders services that is comparable to coverage for physical illnesses. Eight years later, it remains difficult for those who need treatment to find and afford it. The federal government has been very slow to implement rules under the law and state governments are, by and large, simply not enforcing parity requirements. The new parity rules for Medicaid recipients will not go into effect for another 18 months, which means that many low-income consumers with behavioral health conditions may continue to suffer through lack of access to providers and services.
The Center for Health Care Strategies has developed a brief on the various methods by which states are including oral health in payment and delivery system reform programs. Particularly notable has been the focus on oral health reforms among states receiving State Innovation Model grants from the Center for Medicare and Medicaid Innovation. However, the brief also reviews practice-level reforms and statewide delivery reform models.
As reported in a New York Timess article, a recent IRS ruling may create an obstacle to the formation of Accountable Care Organizations (ACOs) that include non-profit hospitals and which coordinate care for people with private insurance as well as Medicare. The IRS has denied a tax exemption sought by an (as-yet undisclosed) ACO that coordinates care for people with commercial insurance. The ruling does not affect ACOs formed solely to participate in Medicare but it could affect similar entities serving privately insured patients. Many ACOs coordinate care for both Medicare beneficiaries and privately insured patients. If the ruling is upheld, it would create a serious obstacle for non-profit hospitals wishing to participate in ACOs.