What the rule means
Insurance plans must treat mental illness the same as physical illness. For example, you can’t be charged higher co-pays or deductibles for mental health and addiction treatment than for other kinds of illness. Likewise, if your health plan allows you to go out of state for, say, a hip replacement, it must also allow you to go out of state for treatment of mental illness. The rule also provides clarity on how parity applies to residential treatment and intensive outpatient services, both of which are important in addiction treatment.
The rule, in itself, does not require your company or your insurer to cover mental health treatment. It only requires that, if a company does cover mental health and addiction, its coverage may not differ from the coverage it offers for physical illness.
Mental health parity, a timeline
Mental health advocates have struggled for decades to achieve mental health illness.
Congress passes the Mental Health Parity Act, and President Clinton signs it into law in 1997. The law equates mental illness with physical illness. But it does not apply to addiction treatment, nor does it require employers to provide mental health coverage.
The Mental Health Parity and Addiction Equity Act passes. There is still no requirement that employers offer mental health coverage. But the new measure adds addiction treatment and reinforces the premise that the law views mental health and physical health the same way. President George W. Bush signs the bill into law.
Congress passes the Patient Protection and Affordable Care Act, also known as Obamacare. Among many other provisions, the law requires that new insurance plans offer mental health and addiction services.
After five years, the government writes the regulation that supports and interprets the 2008 parity law. The rule is announced Friday in Atlanta.
Rosalynn Carter has tried for decades to convince the world that mental illness is no different from physical illness. On Friday, Carter’s long-held conviction became part of federal law.
U.S. Health and Human Services Secretary Kathleen Sebelius, speaking at the former first lady’s mental health symposium in Atlanta, announced a new federal rule requiring insurers to cover mental illness and addiction in the same way they cover other health problems.
Congress passed the Mental Health Parity and Addiction Equity Act in 2008. But until now, the government had not written detailed regulations in support of the law. The long-awaited pages of fine print recognized the completion of a public policy ideal for Carter.
“I often have said that if insurance covered mental illness the way other diseases like cancer or diabetes are covered, there would be less stigma against these diseases, and we all would benefit from healthier mothers, brothers, workers and friends,” Carter said.
Advocates say that the parity requirements, combined with new requirements for mental health coverage under the Affordable Care Act, represent a profound cultural shift for the nation.
“This has been a dream of Mrs. Carter’s for over 20 years,” said Dr. Thomas H. Bornemann, director of the Carter Center’s Mental Health Program. “It has been her No. 1 public policy goal. I can’t tell you what meaning that gives to her and to all of us at the Carter Center that after this long road – we got it.”
Since the passage of the Parity Act in 2008, most health plans started making changes to achieve compliance. But the rules will spell out exactly what is required to abide by the law. Attorneys, consultants and advocates said they needed to closely study the regulations to determine exactly how they might change the experience of patients seeking mental health and substance abuse treatment.
The rule is supposed to guarantee that insurers won’t charge more for co-pays, deductibles and visits for mental health or addiction treatment. Among its provisions, the government said:
- Ensuring that parity applies to mental health treatment that may or may not be covered under current policies, including residential treatment and intensive outpatient care. These are especially important in the treatment of addiction.
- Requiring greater transparency by health plans.
- Clarifying that parity applies to all parts of the plan, including geographic limits, facility-type limits and network adequacy.
“This is excellent news,” said Dr. Nadine Kaslow, a professor at the Emory University School of Medicine and the president-elect of the American Psychological Association. “It’s one thing to say there’s parity. It’s another thing to put concrete realities behind that.”
Kaslow said the rule should make sure that insurers offer more robust lists of health care providers to treat mental illness and addiction, so that patients do not find that all of the providers on a list are booked up and not accepting new patients. “This should provide real and much quicker access to care,” she said.
As Carter noted, Kaslow and others said the rule will reduce the stigma associated with seeking treatment.
“It’s just a wonderful recognition that mental health is a big issue,” said Ellyn Jeager, director of public policy and advocacy at Mental Health America of Georgia. “Voices are being heard.”
Jeager, who attended Friday’s Carter Center event, noted, however, that there is still much work to be done.
Georgia’s dearth of mental health providers presents a big hurdle, said Cynthia Wainscott, a mental health advocate in Bartow County. Less than half of Georgia’s counties have a psychiatrist, she said.
Too many people with substance abuse and mental health problems don’t get the appropriate care they need – if any at all, Wainscott said.
“We’ve got to fix that and (the parity rule) is a step in the right direction,” she said.
Mental health care in Georgia has had a troubled history.
In 2010, after disclosures of abuse and deaths of dozens of patients at state mental hospitals, the state struck a settlement agreement with the Justice Department that calls for Georgia to move to a community-based system of care. The Carter Center helped to craft that agreement, alongside mental health advocates and others.
Since then, the state has closed at least two psychiatric facilities and has added dozens of new community services, such as crisis stabilization units, which provide short-term care in the event of a mental- or behavioral-health crisis.
Parity with medical services is critical to transitioning Georgia’s mental health system from one that emphasizes institutionalization to a program that focuses on providing people with the care they need in their own communities, said Sue Jamieson, an attorney with the Atlanta Legal Aid Society. Now, it’s up to the state of Georgia to make sure this rule gets implemented, Jamieson said.
Insurers said they supported the parity requirement. And one business group said the parity rules would not hurt its members and in fact might help.
“Having a good mental health benefit and a good substance abuse treatment benefit is likely to reduce some costs on the medical side that you would pick up there if you didn’t have a generous mental health benefit,” said Steve Wojcik, vice president of public policy for the National Business Group on Health, a 300-member association of large companies that focuses on health benefits and health care issues.
Ken Thorpe, a health policy professor at Emory University, said that for the costly patients battling multiple medical problems, mental illness is often among the list of conditions. Giving doctors the ability to adequately treat all the problems could help make treatment more effective — and even less expensive.
“It will just make it easier for patients to be compliant and for physicians to put together comprehensive care plans,” Thorpe said.
The new rule was the last in a long series of executive actions that President Barack Obama took in response to the massacre of schoolchildren in Newtown, Conn., last December. The adoption of the rule could mean, among other things, that mentally ill people get treatment that helps them avoid turning violent, administration officials said.
Obama and Vice President Joe Biden developed a plan to reduce mass shootings in the wake of the Newtown shootings, after Obama concluded that he could not get gun control legislation through Congress. The New York Times reported that Obama has taken 23 executive actions this year to combat gun violence.
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