Great Q & A post from Michelle Andrews, Kaiser Health News, about the final rules for the Mental Health Parity and Addiction Equity Act...
Mental Health Parity Rule Clarifies Standards For Treatment Limits, Coverage Of Intermediate Care
By Michelle Andrews, Dec 03, 2013
The Mental Health Parity and Addiction Equity Act of 2008 required health plans that offer mental health and substance use disorder benefits to cover them to the same extent that they cover medical/surgical benefits. Among other things, it prohibits having treatment limits or financial coverage requirements such as copayments or deductibles that are more restrictive than a plan’s medical coverage. Interim regulations issued in 2010 clarified some issues about implementing the law.
The final rules, issued last month by federal officials, spell out more specifics. I spoke with Jennifer Mathis, director of programs at the Judge David L. Bazelon Center for Mental Health Law in Washington, about the parity law and the new regulations. This transcript was condensed and edited for clarity.
Q. What issues does this final mental health parity rule address that will be important to consumers?
A. The rule offers a number of clarifications about the parity law. Some of these clarifications concern how parity requirements relate to the Affordable Care Act, and others relate to issues that were not addressed in the interim rule.
Plans don’t have to cover mental health benefits, but if they do, they generally have to cover inpatient and outpatient services, emergency care and prescription drugs. This final rule says that within a category, such as outpatient care, plans can treat preferred providers differently than non-preferred providers. So it might mean a consumer could have higher copays for non-preferred providers in their insurer’s network for mental health outpatient services than for preferred providers, for example.
The regulation also said that services some would label as intermediate-level mental health services, including residential treatment and intensive outpatient services, are within the scope of the parity law. The regulations say they should be covered at parity. That hadn’t been clear in the interim rules.
Q. The parity law doesn’t allow quantitative differences in coverage, such as fewer office visits or higher copayments for mental health services. But what about other limits that may be harder to measure?
A. The rule provides some clarification on that. These are things like requiring plan members to get prior authorization before receiving services and setting up protocols to determine whether treatment is medically necessary. What the final rules say is that plans must use the same type of processes to determine what is medically necessary or to require prior authorization for both mental health and medical services. If they have a rigorous process for justifying prior authorization for medical services they must have a similarly rigorous process for mental health services prior authorization as well.
Q. What does it clarify about mental health coverage and the Affordable Care Act?
A. The ACA says plans can’t have annual or lifetime dollar limits on the 10 essential health benefits, one of which is mental health and substance use disorder treatment. Normally, under parity you can have those dollar limits as long as they’re at parity with medical service limits. This rule clarifies that the ACA trumps parity in this regard.
Q. Who’s affected by this rule, and by parity more broadly?
A. People who get counseling, psychotherapy, prescription drugs are likely to see the biggest benefit from these rules because those are the services that commercial health plans usually cover. And they already have benefited since the law passed in 2008. This is not a brand new set of rules, this is an update of the rules that already apply. They have benefited and will continue to benefit.
And people on the exchanges who previously had no insurance or bad insurance not only will be able to get insurance now but also insurance with mental health parity.
The ACA also applies parity requirements to insurance plans in the states that adopt the new Medicaid expansion for adults with incomes up to 138 percent of the federal poverty level ($15,856 for an individual in 2013). These regulations do not apply to those plans, but the government says that it will be issuing further guidance about how parity applies to those plans. Parity is likely to be a very important requirement in those plans, which in many cases will cover more mental health services than are typically covered by commercial insurance plans, including services that are used by people with significant psychiatric disabilities. Thus a wider variety of services, used by a wider group of people with mental health needs, will be subject to parity requirements.
Q. What types of health plans are covered by the rule?
A. It generally applies to both fully insured and self-funded large group plans as well as individual and small group plans sold on and off the health insurance exchanges.
Q. What if states have mandated mental health benefits of their own?
A. State parity laws that are more stringent than federal parity laws are not pre-empted. For example, some states’ parity laws require coverage of particular services or benefits on top of the federal requirements. Some states require autism coverage, for example.
Q. What about providers that don’t accept insurance. Does the parity law or this rule affect them?
A. No. That is an issue, certainly for psychiatric services. That’s becoming an increasing concern.
Q. Since the mental health parity law passed, is there any evidence that companies have dropped mental health benefits from their plans so as not to have to comply?
A. According to these regulations, a 2010 study sponsored by the department of Health and Human Services found that, since the 2010 parity regulations came out, only a small percentage of plans have dropped mental health or substance use coverage.
As January 1, 2014 approaches, policymakers and the public are increasingly focused on how effectively states and the federal government will enroll the uninsured into coverage under the Patient Protection and Affordable Care Act (ACA). Over the last four years, the Robert Wood Johnson Foundation's Maximizing Enrollment program worked with eight states to transform state enrollment systems, policies and procedures for Medicaid and CHIP and to prepare for the ACA's enrollment requirements. This briefing will share lessons learned that may be useful for state and federal policymakers as ACA implementation moves forward. Panelists will highlight state innovations that make enrollment faster, more efficient, and more effective, and will define realistic expectations for participation levels under the ACA. Susan Dentzer will moderate this panel discussion highlighting successful enrollment strategies in 2014 and beyond.
Network faithful Regenia Hicks, formerly with the American Institutes for Research Technical Assistance Partnership is taking her creative talents and long history of leadership in the system of care movement to Houston, Texas. In Houston, Regenia will be heading up a new mental health jail diversion program. Excellent choice Houston! We will miss seeing Regenia heading up national meetings and forums on children's mental health, as she has done so well for the past 11 years. Before that, Regenia was an integral component to developing systems of care nationwide going back to the early days of the movement. It is only fitting that she is taking her talents back to the state of Texas where she first made her mark in this field. Something tells us her groundbreaking leadership will soon catapult her efforts in Houston back on to the national stage for replication and inspiration.
Good luck with your new venture Regenia! We can't think of a better bon-voyage and wishes for good luck than Archie Bell and the Drells singing "Tighten Up." Goin' old school on this one folks!
Enter for your chance to win a $100, $50, or $25 gift card. Take a photo of your own, or find one on Flickr with a Creative Commons license, and create your very own mental health meme that shows how you manage your mental health. The strengths-based memes from 18-30 year olds with the most likes will win 1st, 2nd and 3rd place. Winners' memes will appear in the next issue of Focal Point.
- Mental Health Meme Contest: Deadline Dec 17th
Network faithful are encouraged to read an enlightening report from the Brookings Institute on the Supplemental Nutritional Assistance Program (SNAP).The report addresses the impact of cutting SNAP funds on children and families. Read the report and increase your knowledge:
- From the report: Recent policy debate around SNAP has focused on the program’s provision of benefits to able-bodied adults without dependents, more commonly referred to as ABAWDs. In particular, there is concern among some policymakers and observers that the program is too generous and may serve as a disincentive to work. However, the characterization of SNAP as a program that discourages work on a wide scale for childless adults is not well-founded for several reasons. First, nearly nine out of ten SNAP recipients live in a home with at least one child, one disabled individual, or one elderly individual. Second, SNAP simply does not provide enough benefits to support a comfortable life without work. In periods of normal labor markets, most adults can only receive three months of benefits every three years if they are unemployed. Even then, the average benefit is less than $1.40 per meal—hardly enough to entice a worker to forego employment. Finally, many Americans rely on SNAP as a temporary support system when income is low, not as a permanent benefit. In any given year, most Americans will not participate in SNAP—prior to the Great Recession, participation rates peaked at 11.6 percent. But, about half of Americans will rely on SNAP at some point between the ages of twenty and sixty-five.
Food insecurity and obesity are just two of the many struggles endured by low-income families in America, including those living in poverty at a given moment in time and those in the lower-middle class, often on the edge of poverty. On December 4th, The Hamilton Project will release three new papers and host a forum to highlight challenges faced by struggling lower-middle-class families.
The first panel in the forum will focus on a new proposal by Diane Whitmore Schanzenbach of Northwestern University to strengthen SNAP. Schanzenbach makes the case for protecting and maintaining existing budget resources and also offers five reforms that could strengthen SNAP, including incentives for healthier foods to promote better nutrition and a number of changes to the benefit formula.
A second panel will feature a new proposal by Melissa Kearney and Lesley Turner of the University of Maryland for a secondary-earner tax deduction targeted at lower-income, dual-earning families with children in order to help “make work pay.”
For the full agenda and to register for the event, click here. The new papers will be available on The Hamilton Project website (www.hamiltonproject.org) at 8:00 a.m. on December 4th.
- Read the full report here.
This December 5th, join Creating Community Solutions in a nationwide discussion on mental health….via your cell phone! All over the country, on the same day, people will get together in small groups for one-hour discussions on mental health.
The process is simple: join 3-4 of your friends, family, classmates, students, and/or colleagues and text “start” to 89800. Your group will then receive polling questions, discussion questions, and process suggestions via text messaging.
“Text, Talk, Act on Mental Health” is designed to engage high school and college students in particular, using technology that is ubiquitous in their lives. Results from the live polling questions will be tabulated almost instantly, so that people will be able to see how participants across the country responded. The discussion questions will provide a safe space for candid dialogue on mental health, one of the most critical and misunderstood public issues we face. The process will also provide an opportunity for participants to discuss actions they can take to strengthen mental health on their campuses and in their communities.
- Can you give one hour of your time to talk mental health matters?
- Gather your group on December 5th, text "start" to 89800 and join the conversation!
- Join via Twitter (@MentalHealthCCS) and Facebook (fb.com/CreatingCommunitySolutions) using the hashtag #TextTalkAct
Click here to receive reminders and materials before the event!
Download your copy of the Text, Talk, Act Infographic and send it along to recruit participants for your dialogue today!
- Learn more here.
Families USA has a new tool to collect stories from people who have gotten health coverage thanks to the Affordable Care Act. The story collection tool is now live and accepting stories at MyCoverageStory.org.
Please take this opportunity to share MyCoverageStory.org with your networks and communities, and encourage people you know to share their stories, especially those that involve receiving mental health services. Whether it’s an uncle with a pre-existing condition, a neighbor whose job doesn’t offer health insurance, or a sister who has recently been laid off, we all know someone who benefits from the Affordable Care Act—and it’s important to document their powerful stories.
Through its Clinical Scholars program, the Robert Wood Johnson Foundation is collaborating with the United States Department of Veterans Affairs to foster the development of physicians who can lead the transformation of Americans' health and the healthcare system. These future leaders will conduct innovative research and work with communities, organizations, practitioners, and policy makers to address issues essential to the health and well-being of all Americans.
The goal of the program is to integrate the clinical expertise of scholars with training in program development and research methods to help them find solutions for the challenges confronting the U.S. healthcare system and the health of U.S. communities. The program offers master's degree graduate-level study and research in a university-based, post-residency training program. The program generally involves two years of study, with generous protected time for research.
To be eligible, physicians must be committed to a career in academic medicine, public health, health policy, or another career congruent with the program's purposes and priorities of developing physician leaders and skilled researchers; be highly regarded by those responsible for their clinical training; complete the clinical requirements of their residency training by the date of entry into the program (except for surgeons); and be U.S. citizens or permanent residents. Both M.D.s and D.O.s are eligible to apply. Applications are encouraged from candidates with diverse backgrounds and clinical disciplines.
The program will select up to twenty individuals in 2014 for appointments beginning July 1, 2015. The first-year scholar stipend is $69,500, with an increase the second year. In some cases, VA stipends may be higher. Additional financial support is provided for research projects and professional travel.
The Notah Begay III Foundation has announced a Request for Proposals for the Native Strong: Healthy Kids, Healthy Futures grant program.
The purpose of the program is to partner with Native communities to better understand the root causes of childhood obesity and type 2 diabetes, resulting in strategies and an action plan to address the issue.
Grants of up to $20,000 each will be awarded.
Applications will be accepted from grantees anywhere in the U.S. Priority will be given, however, to grantees from the Southwest (New Mexico, Arizona), the Upper Midwest (Minnesota, Wisconsin), and the Southern Plains (Oklahoma, Texas).
In the "things are not always as it seems" category, the state of Maryland has been identified as having excluded students five times the national average in reports of success on national reading tests. The state excluded learning disabled and English learners in their report. The state led the nation in excluding students on the 2013 National Assessment of Educational Progress, posting rates that were five times the national average and more than double the rate of any other state.