Mental Health Parity Journey Continues On Long And Winding Road

Although progress is being made in achieving parity between mental health/substance use treatment and medical/surgical benefits, there’s a long way to go. That’s according to a report by the National Alliance on Mental Illness (NAMI). The report was based on a survey of 2,720 consumers and an analysis of 84 insurance plans in 15 states.

Laws only go so far. Both the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) and the Patient Protection and Affordable Care Act (ACA) strengthened and extended parity requirements. In addition, under the ACA, mental health and substance use disorder services were mandated as one of ten categories of essential health benefits required for all plans sold though the Health Insurance Exchanges. Nevertheless, “it is well known that efforts to achieve meaningful social change are far from over when laws are passed. Achieving true equity in accessing mental health and substance use disorder care requires vigilant attention by advocates and public agencies responsible for enforcement,” according to the report.

Barriers include access, cost. The barriers that people with mental illness and substance use disorders encounter in their efforts to obtain quality care include finding mental health providers in their health plans and accessing psychiatric medications. In addition, the report found that insurers are denying authorization for mental health care at higher levels than they are for other types of medical care.

The report also found that high out-of-pocket costs for prescription drugs appear to discourage people from participating in both mental health and other medical treatment. In addition, high co-pays, deductible and co-insurance rates create further barriers to treatment.

Enforcement, information needed. The report makes the following recommendations:

• Strong enforcement of the MHPAEA is needed at both federal and state levels, including establishing easily accessible procedures for filing complaints.
• Insurance companies should be required to publish the clinical criteria used to approve or deny mental health and medical/surgical care.
• Health plans should be required to publish accurate lists of providers included in their networks and to update them regularly.
• The Department of Health and Human Services should require all health plans to provide clear and understandable information about benefits and to make this information easily accessible.
• Congress and the Executive Branch must work together to decrease out-of-pocket costs under the ACA for low-income consumers.

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