It’s been over a decade since The Mental Health Parity and Addiction Equity Act sought to level the playing field between medical and mental health benefits. With some exceptions, health plans are required to provide the same coverage for medical and mental health when it comes to treatment limits and payment amounts. But practically speaking, have we really reached parity in coverage?
In her testimony last week before the House Subcommittee on Health, Employment, Labor, and Pensions, Dr. Christine Yu Moutier, Chief Medical Officer for the American Foundation for Suicide Prevention (AFSP) reported that “recent analyses found evidence of lack of parity in behavioral health services compared with medical/surgical in terms of high out of network use and lower reimbursement for behavioral health services – and these disparities are trending in the wrong direction.”
There are a number of obvious ways that health plans may be violating parity requirements such as having to call to get permission for coverage, not providing criteria for denial on the basis of medical necessity, or not covering residential mental health treatment or intensive outpatient care when they do so for medical conditions. But there are other not so obvious issues affecting mental health parity. For example, the “inability to find any in-network mental health providers that are taking new patients, but can for other health care” is a significant roadblock.
Another way that insurers have narrowed the scope of mental health coverage is by developing internal guidelines that are more restrictive than the generally accepted standards of care required by law. And, as noted in our article on “Proactive Mental Health,” there is also a significant disparity in how insurance companies promote physical health vs, mental health screenings.
There are also gaps within the law itself that affect countless individuals and their families. The Affordable Care Act expanded parity rules to include individual and small group plans, but employers with fewer than 50 employees who self-insure, self-funded non-federal governmental plans and some fee-for-service Medicaid options are exempt. In addition, Medicare has a 190-day lifetime limit on inpatient psychiatric care, which does not exist for inpatient medical care.
A study by Milliman looked at claims data for over 37 million people across the US; the results showed nothing less than a significant disparity in primary care versus mental health office visits.Primary care received more than 5X the claims and 30%-50% higher reimbursement rates compared to mental health office visits.
Gaps in parity
laws, lack of access to in-network providers and restrictive internal
standards are among the many ways that mental health parity is a goal that we
are far from reaching. Experts, with the data to back it up, are telling us
these disparities continue to exist and, equally concerning, are trending in
the wrong direction. This trend negatively impacts individuals and providers
alike. So how are we doing? In short, we need to be doing better.