Lockup Doc

Those with mental health and substance abuse problems have long faced discrimination from third-party payers. Payment for such conditions has typically been handled differently from “physical” health problems.

A news release today from the U.S. Department of Health and Human Services today explains that the Obama Administration has issued new rules that will require parity in the treatment of mental health and substance use disorders.

Here is an excerpt:

“Workers covered by group health plans who need mental health and substance abuse care deserve fair treatment,” said Deputy Treasury Secretary Neal Wolin. “These rules expand on existing protections to ensure that people don’t face unnecessary barriers to the treatment they need.”

The new rules prohibit group health insurance plans—typically offered by employers—from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits. The rules implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

MHPAEA greatly expands on an earlier law, the Mental Health Parity Act of 1996 which required parity only in aggregate lifetime and annual dollar limits between the categories of benefits and did not extend to substance use disorder benefits.

The new law requires that any group health plan that includes mental health and substance use disorder benefits along with standard medical and surgical coverage must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review. These practices must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits.

As a psychiatrist, I regularly see the adverse effects of people having no means to pay for treatment for psychiatric and substance abuse conditions, and I applaud the good intentions of these new parity rules. I realize that opponents will cite these rules as one more factor that will increase health care costs at a time when we cannot afford it. However, the costs to society of untreated mental illness, alcoholism, and drug addiction are significant and must not be ignored.

Sounds great, right?

Here’s what worries me. The underlined portion of the excerpt above clearly states that parity applies to any group health insurance plan that includes mental health and substance use disorder benefits. It says nothing about having to include these benefits.

So, if health costs are skyrocketing, then isn’t the obvious cost-control solution (the loophole in the new parity rules) going to be simply to drop mental health and substance abuse coverage from insurance plans?

What do you think?

Read the press release here.

Photo Credit: Mike Licht