Parity Act Slow to Catch On

In January 2011, the American Psychological Association (APA) reported that nearly 90 percent of Americans have never heard about mental health parity or of the Mental Health Parity and Addiction Equity Act of 2008. In a survey conducted for the APA in December 2010 by Harris Interactive, 89% of those surveyed said they had not heard about the federal law that affects people who have health insurance through a group or employer plan. Only 7% even recognized the phrase ‘mental health parity.’

The American Psychiatric Association(aPa) participates in the Mental Health Parity Watchalong with 11 other organizations. This organization is aimed at educating the public about parity, recording and appealing problems experienced by consumers in accessing mental health benefits, and in general facilitating the broad dissemination of information about the parity law. The aPa reportedon it’s intervention with BCBS-IL regarding their new requirements for preauthorizations for mental health treatment. While BCBS-IL rescinded their requirement for 2011, it is this kind of action by insurers that the law was meant to prevent.

Companies like Aetna have added pages to their web sites on mental health parity. These are designed to communicate directly to members and panel providers what positions the company has decided to take relative to the law. This can be an excellent way for consumers who have health insurance to learn how their insurer plans to address the requirements of the law.

As part of the parity implementation coalition mentioned above (Mental Health Parity Watch), the National Council has produced fact sheets and other resources aimed at educating consumers and answering questions about the law. Their are additional resources available on their blog page including summary of the law, FAQ, and a Parity Toolkit.

What has been your organization’s experience with the parity legislation so far? Have you found that insurers are moving forward with equivalent benefits and preauthorization policies for both physical and mental health? If you have run into difficulties, what have they been and how have you handled them.

Please share your experience to date. Thanks for your comments!

Managed Care Organizations Oppose Parity

An organization called the Coalition for Parity, Inc. comprised of managed behavioral health organizations (MBHOs) has filed suit to halt the implementation of the Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act. This group has as some of its members Value Options, Magellan Health Services Inc., and Beacon Health Strategies Inc.

As reported by Open Minds and American Psychological Association Practice Organization, the lawsuit challenges the rulemaking process and has requested a temporary restraining order to stop the rulemaking process from moving forward. They argue that the Departments of Health and Human Services, Labor and Treasury overstepped their rulemaking authority in how they interpreted the statutory language and violated federal rulemaking procedure in publishing the rule as they did. While the judge denied the temporary restraining order because the law will not be enforced until July 1, 2010, the court will hear the case as presented by the parties to the action.

On May 9, 2010, the NY Times reported that insurance companies and employer groups are also objecting to the rules.

In a suit over the rules, Magellan and other companies said the concept of nonquantitative limits was “boundless and ill defined” and would reach virtually every policy and procedure used to manage mental health benefits.

As most mental health providers can readily attest, the procedures used by insurers and managed care organizations to limit costs and usage of behavioral health services have themselves been “boundless and ill defined”; after all, a treatment plan certainly could not be a valid treatment plan if it is printed on the wrong form. The MBHOs have been innovative in their development of “every policy and procedure used to manage mental health benefits.” Unfortunately, most of that management has consisted of denying or limiting the amount of service provided and placing onerous requirements on providers.

The NYTimes article states that:

One premise of the law is that mental illnesses often have a biological basis and can be treated as effectively as many physical ailments. But insurers say it is impossible to use the same techniques in managing the treatment of colon cancer and schizophrenia, or heart failure and major depression.

What do you think? Is it reasonable to assume that mental illness and addiction can be managed using the same techniques as are used to manage the treatment of cancer or heart disease?

Please share your comments below.

Mental Health Parity….finally

Based on discussion on the SOS User Forum and comments on our first blog entry, the passage of parity of mental health services with those in the general health arena is a pressing issue for our users. In fact, this is a landmark event in the entire behavioral health community. There is considerable discussion in the newsletter world and in the blogosphere about the final approval of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, a bill that was rolled into the financial rescue package approved by Congress last week. Senators Wellstone and Domenici started work on this bill twelve years ago. Sen. Wellstone was killed in an airplane crash in 2002, but Sens Domenici, Kennedy and others had actively worked for passage of the bill and consider it a major part of their body of work and a tribute to Paul Wellstone.

What will the effect be for providers of mental health services? Will there be differences in effect if you work in the public vs. the private arena? What do you think the impact of this bill will be for your organization? What’s your take on this historic event?

Monica Oss, CEO of Open Minds, indicates that the legislation becomes effective October 2009 and should be implemented by most plans by January 2010. She believes the ramifications will be far-reaching and will occur over the next several years. She suggests the following impacts among others:

  • Behavioral healthcare spending currently misclassified in primary care and emergency rooms will start to be properly classified.
  • Insurance premiums will increase slightly.
  • Funding for mental health and addiction services may be distributed more between public funding and private insurance sources.

Read her entire article at http://www.openminds.com/email/ossmonicaparity100608.htm 

Vince posted NPR’s story in his comment yesterday:  http://www.npr.org/templates/story/story.php?storyId=95435676. You can find other stories at http://www.medicalnewstoday.com/articles/124341.php; http://psychiatrist-blog.blogspot.com/2008/10/mental-health-parity-and-financial.html