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Stepping up Mental Health Coverage

The nytimes is reporting:

The Obama administration on Friday will complete a generation-long effort to require insurers to cover care for mental health and addiction just like physical illnesses when it issues long-awaited regulations defining parity in benefits and treatment.

While laws and regulations dating to 1996 took initial steps in requiring insurance parity for medical and mental health, “here we’re doing full parity, and we’ve also taken steps to extend it to the people covered in the Affordable Care Act,” the senior official said. “This is kind of the final word on parity.”


It's heavily tied into their program for curbing gun violence, which is helping the effort get bipartisan support. The highlights are:

  • health plans’ co-payments, deductibles and limits on visits to health care providers are not more restrictive or less generous for mental health benefits than for medical and surgical benefits
  • Any geographic or facility-type limitations would have to be comparable for medical and mental health benefits.
  • treatment limits — like restrictions on the number of doctor visits or days in a hospital — cannot be more restrictive for mental health benefits than for medical and surgical benefits
  • final parity rules do not apply to health plans that manage care for millions of low-income people on Medicaid. However, the administration has previously issued guidance to state health officials saying that such plans should meet the parity requirements of the 2008 Medical Parity law (on which these rules are based).
  • The parity law does not apply to Medicare, according to Irvin L. Muszynski, a lawyer at the American Psychiatric Association.

So it's a mixed bag 'cause many of the people who probably most need it are likely poor ('cause of the high correlation between poverty and mental illness) and therefore on medicaid/medicare, but the administration estimates that the new rules apply to about %85 of the population. Some experts doubt the rules will help people 'cause of the lack of mental heath facilities (especially for children) in many parts of the country, but some people expect the news laws to help veterans. Enforcement will be left to the states, which could be problematic as they are already overworked dealing with ACA and sometimes have too close ties to the industry.

Image Source: Hearings to Focus on Implementation of Mental Health Parity and Addiction Equity Act (drugfree.org)

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