The Affordable Care Act intended to improve the quality of healthcare in the U.S. while driving down costs. Millions qualified for Medicaid under the new guidelines, and millions more qualified for affordable insurance plans. Provisions were put into place about who received coverage and the type of care they could pay for with their new policies. Mental health was classified as an essential service, meaning it was guaranteed coverage under any insurance plan.
Insurance Policies Then and Now
Before the ACA, there were several ways patients were robbed of adequate mental and behavioral healthcare:
- Insurance companies rarely covered treatments.
- They often dropped patients with mental and behavioral problems.
- New insurance companies could deny care based on pre-existing conditions.
This left the nation’s most vulnerable populations without any access to healthcare. Low- and middle-income families struggled to pay out-of-pocket and often went without care. Legislation changed these struggles, but new rules for mental health billing under ObamaCare created new barriers. Companies were forced to provide mental health services, and they weren’t allowed to deny coverage to patients — even to individuals who were already diagnosed with conditions requiring expensive lifelong treatment.
In order to make up the difference, insurance companies began:
- Demanding higher co-pays and higher deductibles
- Introducing strict restrictions on covered care
- Shrinking reimbursements paid to professionals
However, they had to provide certain services, such as depression screening, without any out-of-pocket expenses.
Changes to Mental Healthcare Delivery
The Affordable Care Act’s impact on mental health billing options did not go as planned. Instead of opening up care for millions of new patients, many participants found their doctors wouldn’t accept their insurance. Providers simply couldn’t afford the training and software needed to learn the new billing systems. Others were crippled by slow payment processing or simply the low rate of reimbursement offered by many of the largest insurance companies.
Overall, what was the impact of ObamaCare on mental health providers? The industry has seen a serious shift in the way counselors, psychotherapists, psychiatrists and others care for patients. While practices used to be small, often located in the provider’s home, more of today’s mental and behavior health professionals are joining larger care groups. They’re joining forces with peers in general medicine and other specialties in order to provide their new pool of patients with the care they deserve. However, that is not the only choice available.
How Has the New Administration Affected “Obamacare” Mental Health Coverage?
One of the main priorities of the Trump Administration and the Republican Party has been dismantling “Obamacare,” and mental health care provisions could suffer as a result. Politicians have been partially successful so far, striking down certain provisions of the law and supporting some states in sidestepping the law entirely. Part of this effort has included changes to Medicare. Some of these changes may affect medical billing and some may not. Here are the main categories to know:
- Budget cuts: Trump’s 2019 budget includes a net loss for Medicare of 236 billion dollars over ten years. Though it’s not clear where this money would come from, it’s likely it would be deducted from the sum the government pays out on claims to doctors, rather than the amount recipients get in benefits.
- Medications: Trump’s budget would also eliminate the provision stating that certain drugs — like IV infusions, vaccinations, allergy shots and cancer drugs — are reimbursed under Medicare Part B if they are supplied and administered by the doctor in their office or outpatient facility. The plan would shift the coverage to Part D, meaning the patient would need to fill their prescription and bring it to the doctor for administration. This shift would result in inconvenience for patients, but could mean lower costs for both doctor and patient. You will need to investigate whether any drugs you normally prescribe — or have a psychiatrist prescribe — fall under this provision.
- No caps on outpatient therapy: If any of your patients receive psychiatric outpatient treatment, they will not have to worry about caps on how much treatment will be covered.
These are just current changes to Medicare that may affect you or your patients. If “Obamacare” is repealed, the changes will be another matter entirely.
What Happens if Trump Changes “Obamacare” Further?
It’s impossible to know what Trump might successfully replace the Affordable Care Act, or “Obamacare,” with, but given the indifference of previous Republican administrations to preexisting conditions and mental health issues, the likelihood of a plan that is stronger than “Obamacare” on mental health is unlikely. Mental health practitioners should be prepared to face a situation where fewer of their patients are covered by their health plans or Medicare. It may become necessary for you to help devise payment plans and strategies for those who are not able to pay out of pocket.
If the current administration is replaced in 2020, we could see a completely different mental health landscape. Many Democrats are proposing a single-payer healthcare system like Medicare for All. If such a system becomes law, everyone could conceivably receive the mental health care they need for free, paid for by the government. If this is the case, you can expect a much greater influx of patients and a much more time-consuming billing process.
Whatever the new plan is, BPS Billing will provide the software that will allow you to make effective claims as easily as possible.
Considering Other Options
Mental health professionals have been hit especially hard because of the self-contained nature of many practices. It isn’t rare for a counselor to be both a care provider and an accounting department. With so many new regulations to learn about and so many different insurance companies to manage, the responsibilities under ACA can feel overwhelming. With the right support, it doesn’t have to be.
It’s surprising how ObamaCare changed mental health billing practices, and it’s inspiring to see the way some providers are morphing to meet their patients’ needs. Knowledgeable mental health billing specialists at BPS will help you maintain your profits while you continue providing care to new and established patients. Learn how your business can benefit today by contacting BPS for a free quote.