Friday, November 8, 2013

New Rule Requires Equal Treatment for Mental Health

By Ron Honberg, NAMI Director of Policy and Legal Affairs

A landmark moment for mental health coverage has taken place. The U.S. Department of Health and Human Services (HHS) issued a long-awaited “final rule” dictating that mental health be covered equal to physical health. The rule finally provides the clarity that is needed to move forward in implementing mental health parity. This is the final aspect of the Mental Health Parity and Addiction Equity Act that was signed into law in 2008.

One important feature of the rule is that it requires insurers to have financial limits (co-payments, deductibles and other out-of-pocket expenses) equal to those of physical conditions. The rule also makes it clear that treatment visits for mental health and substance abuse have no greater limitations than for other medical conditions.

Additionally, the rule requires equity in the criteria that insurers use to make decisions about care. For example, insurers cannot use criteria for denying or limiting inpatient psychiatric treatment that are any more stringent than criteria used for other forms of inpatient medical treatment.

The rule requires insurers to be forthright and transparent about the criteria they use to approve or deny care. This is fundamentally important for individuals and families to navigate the complexities of insurance.

Finally, the new rule makes it clear that parity applies not only to medical treatment but also to vital services and supports essential for many in recovery, including rehabilitative services, case management and residential treatment.

"This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans," said HHS 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."

However, it is important to note that issues remain that will need to be resolved  and details need clarification.

NAMI is disappointed that the federal government has not yet indicated how parity requirements apply to managed care plans offered through Medicaid and the Children’s Health Insurance Program (CHIP). The Administration has promised that they will issue guidance on this important topic in the near future. This is critically important because millions of people living with mental illness are covered through these plans.

Currently, 60 percent of Americans affected by a mental health condition do not receive treatment. With rules requiring parity, we hope that more Americans will receive the care they need and deserve.

NAMI Executive Director Michael J. Fitzpatrick reiterated the significance of these rules in a statement earlier today. “The regulations are a crowning achievement. They are the result of a 20-year bipartisan campaign by individuals and families affected by mental illness to end unfair discrimination.”

NAMI will provide further information and guidance about the new rule in the coming days and weeks—but today is a day to celebrate


lee said...

Nothing to celebrate. While there is an Individual Mandate, there is no Provider Mandate. The current system of the vast majority of Psych Docs in the country and other providers who refuse to take any insurance will continue. Force all providers, all Doctors, Therapists and anyone else with a State Licence to accept Obamacare payouts without charging a surplus. Period.

Genia Gartner said...

Will there finally be provisions for behavioral therapy for autism spectrum disorder?

Jennifer said...

It sounds as if Medicare cannot limit psych inpatient days to 190 (lifetime), is that correct? If so, doesn't that disregard the parity treatment rulings?

gomichigan said...

This is wonderful and I know that many many people are to thank ~ Thank You!!!

Anonymous said...

When will this rule start to actually be implemented? Is this something that we can expect to happen in the near future? Will my insurance company be forced to start covering mental health services?

Francis Kittredge said...

We are still subjected to overt bigotry in the workplace. When will that change?

Ryan said...

Hopefully this news is the first step toward ending discrimination endured by myself and thousands of others at hospitals.

The following is a direct quote from a letter I received from Providence Centralia Hospital in Washington State:

"Unfortunately. our physicians are trained to take care of patients that present with acute medical conditions. They are not experts in mental illness and often defer the management of this to the patient's primary care provider caring for this aspect."

This was in response to a complaint filed with the Joint Commission against this hospital for both the horrible, discriminatory treatment I received as well as what I would term ABUSE I witnessed of a patient who was brought in following a suicide attempt.

I went to this hospital for previously scheduled cardiac testing to find the cause of nearly a year of extreme physical misery. To ensure I received the best possible care, I was honest about my mental health issues. Instead of acting with compassion, my doctor threatened me into being admitted, despite the fact that I had made no actual suicide threat and had repeatedly stated that I wanted help with my physical suffering.

My stay was a nightmare. I was ignored, ridiculed, and eventually kicked out once the hospital had run up a huge bill. After all of this, I had no answers as to why I felt so sick for so long. When I saw the doctor for the final time, I asked him what I should do to get the help he refused to provide. "I don't know," he shrugged, and walked off.

The other patient I mentioned? He became so furious at the hospital staff's treatment that he eventually stormed out of the room in a fit of anger. To the best of my knowledge, they simply let him go, while I was not yet permitted to leave, despite my being far less volatile. What was the difference between this other patient and myself? He did not have insurance.

These are just the barest details of my story. What is worse is that I have spoken to many people with similar- and even worse- stories about this very same hospital.