Sarah Ferris has written a new tip sheet for AHCJ members that provides ideas on exploring how partial or complete repeal of the Affordable Care Act could reduce access to mental health care for millions of people.
This comes at a time when the country is grappling with an opioid addiction crisis and scores of people are without adequate access to behavioral health care. Continue reading
Later this year, health plans will be under new mental health parity rules affecting how insurers should cover patients with mental health and substance abuse disorders.
Michelle Andrews, a health policy reporter and columnist for Kaiser Health News, explains the issue in a new tip sheet, “Mental health parity rule clarifies standards for treatment limits, coverage of intermediate care.”
These rules, governing the limits that health insurers can place on coverage for patients needing mental health and substance abuse care, will be important to consumers for several reasons. One reason involves what services health plans must provide when covering mental health benefits –keep in mind that health plans do not need to offer mental health care. But if they do, they need to cover inpatient and outpatient services, emergency room care and prescription drugs, Andrews reports. Also, the rules prohibit health insurers from setting limits on treatment that are more restrictive than the limits set on a plan’s medical-surgical coverage, she adds. Continue reading
Phyllis Vine of MIWatch.org, a site about mental illness, writes that last year’s mental health parity legislation has run into problems. According to Vine, if federal rules for implementing the Wellstone-Domenici Mental Health Parity and Addiction Equity Act are not in place by the Oct. 3 deadline, treatment for many could be delayed or stopped.
The act requires insurers to treat mental illness the same way they do physical ailments, eliminating higher co-pays, deductibles and limits on hospital stays. Vine provides some background:
We should recall that parity was hotly debated before two bills (HR 1424 in the House, S 558 in the Senate) were folded into last year’s stimulus package. It was an initiative supported by a unique collaboration between advocates in the mental health community and those in the addiction community, with coverage extending to the self-insured and to those in Medicaid managed care. The House initiative, led by Reps. Patrick Kennedy and Jim Ramstad, wanted to base treatment criteria on the American Psychiatric Association’s Diagnostic and Statistical Manual. Insurance and business were able to determine that the Senate’s bill allow them to define “medical need.”
Vine writes that insurance companies are now trying to sabotage the law in an attempt to preserve profits. Letters from the American Benefits Council and Wellpoint Inc., sent during the public comment period, ask for exclusions of some conditions, treatments, providers and limits on the number of visits patients can make.