[insert your agency letterhead]
Mr. Kevin Counihan, Director
Center for Consumer Information & Insurance Oversight
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
7501 Wisconsin Avenue
Bethesda, MD 20814
Re: Comments on draft ECP list
Dear Mr. Counihan:
As you continue to implement the Affordable Care Act (ACA), I want to raise for your attention an issue that has the potential to derail access to care for millions of America’s most vulnerable citizens – those with mental illness and addiction disorders. Under guidance issued by your agency in 2013, which identifies types of health care providers to be considered“Essential Community Providers” (ECP) under the Affordable Care Act, you did not recognize Community Behavioral Health Centers (CBHCs) as an ECP. This issue is thrown into high relief by your recently issued draft list of ECPs, which is notably lacking in community-based providers of mental health and addiction treatment services.
[Your organization name, include brief description of your organization.]
[Your organization name]is a strong supporter of the ACA, and we want it to be successful. That is why it is critical we ensure CBHCs are recognized as ECPs. Current Administration guidance, which allows insurers to count CBHCs against their quota for ECPs while not specifically identifying our organizations as ECPs, diminishes the important role our services play in ensuring the whole health and well-being of the 1 in 5 Americans living with a mental health or substance use disorder. We respectfully urge you to revise current guidance so that CBHCs will be included within the definition of essential community providers.
Community Behavioral Health Centers have long stood as the primary access to community care for eight million Americans who live with severe and persistent mental illness or addiction disorders. Enactment of the ACA was ground breaking for this population in that it has the potential to expand coverage formany who currently are uninsured or under-insured. However, if QHPs are not encouraged to include CBHCs in their provider networks, long standing relationships with providers could be impacted and disruption in treatment regimens could occur.
Though we understand that 45 C.F.R §§ 156.230 and 156.235 do not explicitly identify CBHCs as ECPs, we believe the language that states “Essential community providers are providers that serve predominantly low-income, medically underserved individuals…” clearly indicates the intention of Congress to include CBHCs and provides authority for the agency to include in its guidance recognition of CBHCs as ECPs and maintain a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance abuse services, to assure that all services will be accessible without unreasonable delay.Of the eight million Americans that CBHCs serve, 43 percent are uninsured or under-insured and 37 percent are covered by Medicaid. Expanding the list of recognized entities to include CBHCs will ensure that Americans with severe and persistent mental illness or addiction disorders are able to continue accessing the care they need with providers they know and trust.
Thank you for your attention to this important matter.
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