Supreme Court Rules Affordable Care Act as Constitutional – Major Implications for Behavioral Health

Law of the Land – Behavioral Health Treatment is Essential Health Benefit. What it Means for California and SB 946.

Today the US Supreme Court upheld as constitutional most of the federal health care reform act – officially known as the "Patient Protection and Affordable Care Act" – including the individual mandate requirement. The court upheld the individual mandate portion of the federal law by a narrow 5 to 4 vote, with Chief Justice Roberts writing for the majority opinion that "...the mandate can be regarded as establishing a condition -- not owning health insurance -- that triggers a tax -- the required payment to IRS..."

The Court's full 193 page opinion can be viewed here: www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf

The decision by the Court to uphold these critical elements of the law will have major impacts for behavioral health treatment across the nation, including the expansion of states' Medicaid programs (called Medi-Cal in California), and a new Essential Benefits Package that health plans must provide. The law ensures health plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges (Exchanges), offer a comprehensive package of items and services, known as "essential health benefits." Essential health benefits must 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

It was the tremendous efforts of behavioral health advocates that resulted in the inclusion of "behavioral health treatment" as an essential health benefit in the federal law. Similar advocacy efforts in California also led to the passage of state law, SB 946, which requires health plans to cover behavioral health treatments for individuals with autism. The mandates in SB 946 become active starting July 1, 2012 and sunset (i.e. are no longer legally required) January 1, 2015; however, today's decision allows room for optimism that the benefits authorized by SB 946 will continue past its sunset. A more detailed report of the impacts of today's ruling on behavioral health treatments in California is forthcoming, after a thorough analysis of the Court's opinion.

Questions and comments can be sent to Jordan Lindsey, Executive Director of CalABA, at [email protected].