Require coverage for MH/SUD services
Recommendation
Congress should require that all types of health insurance coverage – including self-funded employer plans – cover services that are necessary to treat mental health and substance use disorder (MH/SUD) services.
Background/summary
Currently, services that are indispensable treatments for common mental health and substance use disorders (MH/SUDs) are not covered by many public and private payers. For example, commercial plans largely fail to cover Coordinated Specialty Care, the evidence-based intervention for first episodes of psychosis, which often first appear in adolescence and early adulthood. The failure of commercial insurance to cover these services results in cost-shifts to Medicaid and contributes to approximately 75 percent of the 100,000 young people experiencing first psychosis each year not receiving this life-altering treatment. The federal government should not allow such evidence-based treatments to not be covered.[1][2]
citations
1. U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. Recovery After an Initial Schizophrenia Episode (RAISE). Last Accessed October 2022
2. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Center for Medicaid and CHIP Services; National Institutes of Health, National Institute of Mental Health; Substance Abuse and Mental Health Services Administration. Joint Informational Bulletin. Coverage of Early Intervention Services for First Episode Psychosis. Last Accessed October 16, 2015