The Obama administration on Friday released the final regulations requiring that health insurers provide equal coverage for mental and physical ailments, five years after the enactment of a law championed by former U.S. Rep. Patrick Kennedy of Rhode Island.
The Mental Health Parity and Addiction Equity Act of 2008 had been a signature achievement for Kennedy, who co-sponsored it after publicly discussing his own struggles with mental illness. Now, the rules are finally in place to govern how the law will be carried out.
“Today is a very important day,” Kennedy said Friday in a telephone news conference, referring to the “historic process” of advancing treatment for mental illness and substance abuse disorders.
But, he said, “The final rule is not the final word. … This rule is really only as good as the monitoring and enforcement that goes along with it.”
The Obama administration had pledged to complete the parity law regulations as part of its plan to reduce gun violence. This step is intended to increase access to mental health treatment by people who might otherwise turn to violence.
Rhode Island already has its own mental health parity law, passed in 1996 and expanded in 2001, with similar requirements. But the federal rules are expected to fill some gaps, including these:
The self-insured plans that many large employers offer are exempt from state law. With the federal rules in place, they are now required to provide equal coverage for mental health.
The rules prohibit limits on the number of office visits for mental health or substance abuse. State law had allowed insurers to limit outpatient services to 30 visits a year, but federal law supersedes.
The federal rules clarify that parity applies to residential or intensive outpatient settings. State law had allowed insurers to limit community residential care for substance to 30 days a year.
The regulations specify that co-pays, deductibles and visit limits cannot be more restrictive for treatment of mental health and substance abuse disorders than they are for medical and surgical care.
The regulations also state that parity applies to geographic limits and facility-type limits. For example, a plan can’t require in-state treatment for mental illness if it covers medical or surgical treatment out of state, and it can’t refuse coverage for psychiatric hospitalization if it covers other types of hospitalization.
The rules also mandate that provider networks for mental health and substance abuse care can be no more limited than they are for other types of care.
{Zsqf}The parity law applies only to large groups that offer mental health coverage. The Affordable Care Act has similar provisions governing the small-group plans, starting next year. The law does not apply to Medicare or Medicaid. But the administration has provided guidelines to state health officials saying that Medicaid, which serves the poor, should meet the parity law requirements.
Rhode Island’s health insurance commissioner, Dr. Kathleen C. Hittner, said she hadn’t had a chance to review the rules, which were released midday Friday and become effective Wednesday. But she said her office, which is responsible for enforcing the law, is committed to mental health parity.
Chaz J. Gross, executive director of the National Alliance on Mental Illness of Rhode Island, called the rules’ completion “a positive step, a great step.” But he was skeptical of the ultimate impact, asserting that many Rhode Islanders lack access to adequate care despite Rhode Island’s parity law. Insurance companies will find a way around the rules, he said: “They’re going to do everything they can to limit costs and limit services.”
Susan Jacobsen, executive director of the Mental Health Association of Rhode Island, was also measured in her response to the news. “I did jump up and down when the law was passed. Now I think it’s a wait and see,” she said. “I don’t think we’re going to know how well it’s working until we get into situation where it’s not working … until we get to the individual appeals process.”
Oftentimes discrimination occurs in subtle ways that the regulations may not address, she said. For example, children are removed from treatment programs intended to last six months if they start improving after a few weeks. Jacobsen compared that with stopping a 10-day antibiotic if your symptoms disappear after two days. In both cases, the full course of treatment is needed.
Kennedy noted that Iraq and Afghanistan veterans will be among the beneficiaries of the law. Because most serve in the Reserves, they will be covered by private insurance when they come home — and many return in need of mental health treatment.
Twitter: @felicejfreyer
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