Mental Health Parity
Background
Efforts in Congress to enact comprehensive parity requirements
that would prohibit group health plans from treating mental
health benefits differently from medical and surgical benefits
stalled at the end of 2005. Consequently, a one-year extension
of the more limited “Mental Health Parity Act of 1996”
(Public Law 104-206) was agreed to shortly before the 108th
Congress adjourned in December. That legislation mandates
that those health plans offering mental health benefits provide
equal annual and lifetime dollar limits for mental and physical
disorders.
There is strong bipartisan support in the Senate for a comprehensive
mental health parity bill, and President Bush endorsed the
concept of parity in 2002. However, concern about the financial
impact on employers remains strong among many House Republicans,
despite the findings of virtually every independent study
that cost increases would be minimal.
Legislation to extend and expand the 1996 law to ensure greater
parity in the coverage of mental health benefits will be introduced
later this spring. It will prohibit discriminatory mental
health coverage not only in the areas of annual and lifetime
limits but also in inpatient days and outpatient visits and
in copayments and deductibles.
The legislation will only apply to group health plans already
providing mental health benefits and will be modeled after
the mental health benefits provided through the Federal Employees
Health Benefits Program. As announced by the Clinton Administration
at the 1999 White House Conference on Mental Health, Federal
employees began receiving parity benefits on January 1, 2001.
Below are provisions included in this legislation:
- Group health plans cannot set different treatment limits
or financial requirements in such areas as patient copayments
and deductibles, the length of hospital stays and the number
of outpatient visits. The 1996 bill applied primarily to
lifetime limits and did not address routine visits to a
mental health professional.
- The bill explicitly states the legislation may not be
construed to require plans to provide any health benefits;
to prevent the medical management of mental health benefits;
or require the provision of specific mental health services,
except to the extent that failure to provide such services
would result in a disparity between the coverage of mental
health and medical-surgical benefits.
- Coverage is also contingent on the mental illness being
included in an authorized treatment plan, the treatment
plan being in accordance with standard protocols, and the
treatment plan meeting medical necessity determination criteria.
- “Treatment limitations” are defined as limits
on the frequency of treatment, the number of visits, the
number of covered hospital days, or other limits on the
scope and duration of treatment. The definition of “financial
requirements” includes deductibles, coinsurance, copayments,
and catastrophic maximums.
- The legislation does not require plans to provide coverage
for benefits relating to alcohol and drug abuse. It exempts
companies with fewer than 50 employees.
AAGP Position
AAGP strongly supports non-discriminatory treatment for all
Americans with mental disorders and non-discriminatory coverage
of mental health services under all types of health benefits
programs. Arbitrary limits on coverage of mental health care
should be eliminated wherever they exist. AAGP believes that
enactment of comprehensive mental health parity would be an
important step forward toward ending discrimination between
health insurance coverage for psychiatric illness and all
other medical illnesses and achieving parity for mental health
care in all health benefit programs, including Medicare.
March 2005
|
