Friday, November 8th, 2013
Key Provisions of Final MHPAEA Rule by Erica Stocker of McDermott, Will, and Emery
Regarding eating disorders coverage specifically, the Eating Disorders Coalition (EDC) released its initial thoughts on Friday afternoon. EDC notes that while the final rule does not require coverage for residential services, it does require coverage for residential treatment and other intermediate behavioral health services if the insurer or managed care organization (MCO) covers post-acute care services. As EDC noted, this means that if a plan covers chemotherapy (an example of post-acute care services), then it must also cover residential treatment of eating disorders or substance abuse. EDC also stated: “The rule ensures that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings.”
EDC also notes that the final rule clarifies that parity applies to all plan standards, including geographic limits, family type limits, network adequacy. This is a positive clarification for eating disorders given the fact that many travel out of state to receive care. Finally, EDC also expressed encouragement for the final rule’s network disclosure requirements—requiring that MCOs and insurers disclose medical necessity definitions and the process used to construct non-quantitative treatment limits (NQTL)—noting that this has been a significant difficulty faced by those who have been denied coverage for eating disorders.
New rule requires equal treatment for mental illness!
Kelly Kennedy and Aamer Madhani, USA TODAY 12:37 p.m. EST November 8, 2013 (www.usatoday.com/story/mental-health-parity)
Friday’s announcement said insurers must charge similar co-payments and deductibles for mental and physical treatments.
WASHINGTON — Five years after the passage of a groundbreaking law establishing equality between mental health care and other medical treatments, the Obama administration announced its final rule Friday defining how that treatment must be provided.
The rule requires insurers to charge similar co-payments for mental health treatment as they would for physical ailments. It also makes clear that deductible and visit limits are generally not more restrictive for mental health and substance abuse care.
“This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans,” said Health and Human Services Secretary Kathleen Sebelius. “Building on these rules, the Affordable Care Act is expanding mental health and substance use disorder benefits and parity protections to 62 million Americans. This historic expansion will help make treatment more affordable and accessible.”
HHS says the rule also includes several other consumer protections, including ensuring that parity is applied to care received in residential treatment and intensive outpatient settings, and clarifying that parity applies to all health care plan standards, including geographic limits and facility-type limits.
About 26% of Americans 18 and older have a diagnosable mental disorder every year, according to the National Institute of Mental Health.
“The rule will really dictate how parity gets implemented,” said former representative Patrick Kennedy, who worked with his father, late senator Edward Kennedy of Massachusetts, on the Mental Health Parity Act. “We need to, most importantly, have the attitudes in the right places that this is something that’s really going to revolutionize care.”
In 2008, Congress passed and President George W. Bush signed into law the Mental Health Parity and Addiction Act, which demands that mental illnesses be treated the same as other illnesses. The argument: Those who have cancer are not denied care after 10 visits if they are not healthy; those with depression should also not be denied care if they are not healthy.
The announcement came as Sebelius attended a mental health conference at the Carter Center in Atlanta. Former first lady Rosalynn Carter has long been a proponent of mental health parity and was heavily involved in lobbying for the law.
The rule change announcement was made jointly by HHS and the Treasury Department.
“Americans deserve access to coverage for mental health and substance use disorders that is on par with medical and surgical care,” said Treasury Secretary Jack Lew. “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.”
Insurers, including the insurance industry trade group America’s Health Insurance Plans, have argued that it’s too difficult to compare physical illnesses to psychological illnesses in an apples-to-apples way, and they have insisted upon evidence-based guidelines. Mental health experts say they can do that.
The industry also has said the rules could cause premiums to go up. USA TODAY reported Wednesday that there may be an influx of young people diagnosed with mental health issues as they finally gain access to treatment.
However, Kennedy and other mental health experts said, catching those illnesses early may lead to lower costs in the long-term.
Kennedy, who suffers from mental illness, said he expects that the law will help employers save money, because workers will be more productive, and that young people dealing with depression or substance-abuse disorders may get the help they need to allow them to make them productive early-life career decisions.
Also, Kennedy said, improved mental health care will allow mentally ill people with other chronic issues to take better care of themselves.
“I don’t think my liberal mind and bleeding heart will be the reason that this gets implemented,” Kennedy told USA TODAY. “I believe it will be economics.”
But he said everyone in the health system will need to change behaviors to make parity work. Primary-care physicians must ask questions to gain knowledge about a person’s mental health, and then they must understand how to get that person further help. Mental health providers may need to start taking insurance to ensure people have access to care. And insurers will need to be transparent about mental health coverage.
“Doctors check cholesterol and blood pressure, but the notion that in this day and age, they ignore a check-up from the neck up that could make all the difference in all the rest of our health is hard to believe,” Kennedy said. “We’re still stuck in a time warp.”