At the end of last week the Obama administration released its final regulations requiring that health insurers provide coverage for mental health and substance abuse treatment just like physical ailments.
The ruling comes five years after the enactment of the Mental Health Parity and Addiction Equity Act of 2008, which was championed by former U.S. Rep. Patrick Kennedy of Rhode Island.
But “it’s not the final word,” Kennedy said Friday in a conference call with reporters.
He said the rule is only as good as the “monitoring and enforcement that goes along with it.”
The Obama administration had promised to finish the rule writing process as part of its attempt to reduce gun violence.
“These rules expanding mental health care are the single most important step to stem and stop gun violence since the Newtown tragedy,” U.S. Sen. Richard Blumenthal said Friday. “They move America toward treating mental illness before it leads to senseless death and injury involving guns. They will also help millions of Americans who are not dangerous but victims of painful, debilitating, and disabling mental health conditions.”
He said there is “an overwhelming consensus that mental health is largely at the root of the death and injury, senseless massacres, drive by shootings, and domestic violence that take its toll every day in America.”
Kennedy and Blumenthal pointed out that the new rule will help veterans who suffer from post-traumatic stress and traumatic brain injury.
Kennedy said that since most of the veteran population is made up of National Guard troops and reservists, it means they will most likely be taken care of through their employers’ private insurance.
“We really need to be vigilant in enforcing these new rules,” Blumenthal said. “Enforcement is key.”
Connecticut already passed a mental health parity law in 1999. That law covered about 2.4 million individuals in the state, but it didn’t cover self-insured plans often offered by large companies or federal insurance plans. It only covered the plans regulated by the state Insurance Department. The federal rule will help fill in some of gaps by applying mental health parity to self-insured and federal plans.
The federal rule does not cover the Medicaid population. Each state has its own Medicaid plan approved by the Centers for Medicare and Medicaid Services.
“While we are pleased these rules improve access to care for those with commercial insurance, we are disappointed today’s rule does not apply to Medicaid Managed Care, the Children’s Health Insurance Program, and alternative benefits plans and we hope to see the forthcoming guidance from the administration on this important issue within 6 months,” Andrew Sperling, director of federal legislative advocacy for the National Alliance on Mental Illness, said Friday in a statement.
A spokesman for the Department of Social Services said Connecticut’s Medicaid program, which serves the poor, already has general parity in terms of coverage for mental health and medical services.
“We are currently working with CMS to verify that this covers all relevant areas, including authorization processes,” David Dearborn, DSS spokesman, said Friday.
Kennedy said states are going to need the added guidance that comes from CMS on this issue.
“This is clearly a gray area . . . that we need to stay on top of,” Kennedy added.
Dr. Jeffrey Lieberman, president of the American Psychiatric Association, said Friday’s ruling is an historic milestone on the path to parity.
“Finally we have the pieces in place to allow mental health care to be provided more effectively, fully to people in need,” Lieberman said.
But he said implementation of the new rule will require diligence. He said quantifying access to mental health treatment will be difficult to calculate and insurance companies could still “manipulate the availability and access to benefits by placing certain types of limitations on those by requiring prior approval.”
Lieberman’s organization teamed up earlier this year with the Connecticut Psychiatric Association to file a class action lawsuit against Anthem. The lawsuit alleges that the insurance company discriminates against mental illness through its billing practices.
Connecticut’s Healthcare Advocate Victoria Veltri said in a statement that discrimination against mental health and substance abuse treatment comes in many different forms. It could be a requirement for prior authorization, pharmacy management, or the adequacy of the network of doctors, she said.
“Transparency of the health plan decision making process, including any criteria used to determine medical necessity, is fundamental to preserving consumers’ appeal rights,” Veltri said.
She said her team was still reviewing the 206-page document on Friday.
The Connecticut General Assembly passed legislation earlier this year that seeks to improve access for patients with mental illness or substance abuse problems.
The bill requires mental health and substance abuse services to be considered “urgent care” and also shortens the review time for service requests from 72 hours to 24 hours.
That legislation also requires:
—insurance companies to inform consumers that they have the right to appeal a denial of care;
—the Insurance Department to evaluate and report on compliance with mental health parity laws, and;
—the health professional reviewing an insurance claim to have similar qualifications to the medical professional prescribing it.