Feds add teeth to mental health insurance law

By Posted : 11/13/2013

heart in mind illustration depicting mental healthInsurers can no longer treat mental health illness and addiction differently than physical illness now that the Obama administration has set down parity regulations.

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Secretary of Health and Human Services Kathleen Sebelius called the move "the largest expansion of behavioral health coverage in a generation" during a recent announcement at a mental health conference at The Carter Center in Atlanta.

The new law guarantees that mental health benefits match those for medical and surgical benefits, including copayments, deductibles, allowed number of visits to providers, residential treatment and outpatient services.

The detailed regulations sharpen the Mental Health Parity and Addiction Equity Act (MHPAEA), signed into law in 2008 but largely ineffective because of loopholes and the lack of clear guidelines on enforcement and accountability for overseeing its implementation.

"People who either have insurance coverage now and have no mental health coverage or where the Affordable Care Act fills in those gaps for people who have no insurance at all, they will be able to access affordable care with mental health and substance abuse benefits," Sebelius said at the conference, which was hosted by former first lady Rosalyn Carter, a long-time crusader for more expansive mental health care and addiction treatment.

The law comes at a time when Sebelius is taking heat for the botched rollout of the health insurance exchange website, created to help uninsured individuals buy health insurance plans to comply with the Affordable Care Act (ACA).

Under the ACA, people cannot be denied coverage or charged higher premiums due to pre-existing conditions, which includes mental health illness such as depression. It also expands coverage for screening and behavioral assessments without co-payments or out-of-pocket fees.

Specifically, the Department of Health and Human Services (HHS) says the more rigorous MHPAEA rule confirms these provisions:

  • Ensures parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings.
  • Clarifies the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law.
  • Clarifies that parity applies to all plan standards, including geographic limits, facility-type limits and network adequacy.
  • Eliminates the provision that allowed insurance companies to make an exception to parity requirements for certain benefits based on "clinically appropriate standards of care, which clinical experts advised was not necessary and which is confusing and open to potential abuse," according to HHS.

The mental health community has actively pushed for the law, citing the need for more comprehensive treatment across the country. HHS said the regulation could affect 62 million Americans, including about 23 million who suffer from substance abuse.

Administration officials added that the rule was sought, in part, in response to the recent spate of violent shootings, including the massacre of schoolchildren in Newtown, Conn., last December. They hope the rule will help mentally ill people get care before potentially turning violent.

"Americans deserve access to coverage for mental health and substance use disorders that is on par with medical and surgical care," Treasury Secretary Jacob J. Lew said in a written statement. "These rules mark an important step in ending the disparities that exist in insurance plans, and will provide families nationwide with critical coverage and protections that fulfill their health needs."

Mental health advocates: Bravo on health insurance parity law

Cynthia Moreno Tuohy, executive director of the National Association of Alcoholism and Drug Abuse Counselors, praised the rule, saying it will encourage wider access to care. "What it means for us is that we should see more people coming into the treatment world," Tuohy said in a written statement. "One of the reasons people don't come into treatment is that they don't have health care -- this takes those barriers away."

Jeffrey Lieberman, president of the American Psychiatric Association, also cheered the move. He told NBC, however, that health insurers should be watched closely to ensure they don't side-step any requirements.

But America's Health Insurance Plans, a national trade group representing health insurers, said it likes the rule.

"Health plans have long supported the Mental Health Parity and Addiction Act and have worked to implement these requirements in a manner that is affordable, safe and effective for patients," said Karen Ignagni, the group's president, in a written statement. "We appreciate that the final rule enables patients with mental and behavioral health conditions to continue to benefit from the innovative programs and services health plans have pioneered."

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