Equity of Mental Health Services Coverage

source: bls.gov

source: bls.gov

Public Health in the National News – As part of the fallout from the recent school shootings and outbreaks of gun violence, the Obama administration promised to improve mental health services. One of the 23 executive actions taken to reach this goal was to issue the final rule to fully implement the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. Overall, the MHPAEA does not require insurers to provide mental health and substance abuse benefits unless they are being offered through the state insurance marketplaces as defined by the 10 essential health benefits implemented under the ACA. However, if benefits are offered, the final rule signals significant changes to large group health insurance plans by requiring that benefits for mental health and substance abuse services be treated equally to other types of health services, including treatment limitations, financial requirements, and annual or lifetime dollar limits. In addition, the ruling ensures access to intermediate levels of care for residential treatment and outpatient mental health services and clarifies plan participant disclosure rights (i.e., explanation of comparable deductible and visit limits for both mental and general health care). It also requires insurers to charge similar co-payments for mental health treatments and services as they would for physical health problems.  In addition, the final rule also clarifies that the Affordable Care Act trumps parity law by not allowing annual or lifetime limits on essential health benefits, which for mental health and substance use disorder services include behavioral health treatment (e.g., counseling and psychotherapy), inpatient services, and treatment for substance use disorders. The combination of these recent policy changes means improved access to behavioral health services for millions of Americans.

For further information:

General Resources for Mental Health

http://www.mentalhealth.gov

The Insurance Marketplace and Mental Health and Substance Use Services

https://www.healthcare.gov/do-marketplace-insurance-plans-cover-mental-health-and-substance-abuse-services/

Fact Sheet on the Mental Health Parity and Addiction Equity Act

http://cms.hhs.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet.html

Full Text of the Final Rule for the Mental Health Parity and Addiction Equity Act

https://s3.amazonaws.com/public-inspection.federalregister.gov/2013-27086.pdf

This article was written by Kelly Shaw-Sutherland, MPA, a health data analyst in the UNMC COPH Department of Health Services Research and Administration, and Jim Stimpson, PhD, director of the UNMC COPH Center for Health Policy and an associate professor in the UNMC COPH Department of Health Services Research and Administration.