As someone who lives with rather major mental health issues on a day-to-day basis, I thought it’d be useful to compile a list of links that I personally find helpful, in the hope that maybe some of my followers can get something out of it.
Mental health parity laws are based on the premise that insurers should provide similar coverage benefits for mental health treatment as they do for medical and surgical treatment. Historically, insurers have not provided equal coverage to their members for mental health conditions—either by providing no benefits at all, by imposing financial barriers such as through higher copays and deductibles, or by limiting treatment through caps on doctor visits and hospital stays, or through more restrictive annual and lifetime dollar limits on coverage.
Federal Health Parity Laws
Congress took the first step towards mental health parity with the Mental Health Parity Act of 1996 (MHPA). The MHPA mandated parity between mental and physical health services with respect to annual and lifetime and dollar limits on coverage. The following year, Congress extended MHPA requirements to all SCHIP plans and Medicaid managed care plans. The law was extremely limited in scope, however; it only applied to group health plans and contained an exception for small business employers. It also did not compel insurers to provide mental health services. Furthermore, insurers were free to circumnavigate the law altogether by limiting treatment options or through higher cost sharing requirements on mental health services. Finally, Congress undermined the law from its inception by including a sunset provision on the law that had to be extended six times before a new mental health parity law was passed.
Over a dozen attempts were made in Congress after the first Mental Health Parity Act to provide additional parity coverage, but little legislative action was taken until the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA became fully effective in January 2010 and addressed several of the shortcomings in the previous federal mental health parity law. Under the MHPAEA, health insurers and group health plans must guarantee that cost sharing requirements on mental health benefits and limitations on treatment are not more restrictive than requirements and restrictions for medical and surgical benefits. Unfortunately, the MHPAEA did not remedy all of the flaws in the MHPA. Parity protections were still limited to group health plans; like its predecessor, the MHPAEA did not apply to the individual health insurance market. And, like the previous mental health parity law, the MHPAEA in no way mandated that insurers provide mental health benefits, only that if they chose to do so, the plans they offered must comply with the MHPAEA’s parity provisions.
Despite their flaws, these mental health parity laws have helped a substantial number of patients get necessary care, and what is more, have done so at minimal cost to insurers. Actuarial reports and Congressional Budget Office studies of the federal mental health parity laws predicted less than a 1% increase in health insurance premium costs. Research on states’ experiences with parity legislation also consistently found little effect on spending through the implementation of mental health parity laws; in fact, they resulted in a reduction of out-of-pocket expenditures for some states.
The passage of the Patient Protection and Affordable Care Act (PPACA) greatly expands federal requirements for mental health treatment and parity. It establishes, for the first time, federal mandates that mental health services be provided as part of an “Essential Health Benefits” package that individual and small group plans must provide. While the PPACA gives the Secretary of Health & Human Services the ultimate say in what constitutes essential health benefits, HHS’ current interim policy allows states to benchmark its own essential benefits package to one of several existing employer-based insurance plans.
While the exact composition of mandated mental health services will vary from state to state, federal parity requirements will not. The PPACA extends existing federal mental health parity law to cover three main types of plans: qualified health plans available on health insurance exchanges, Medicaid non-managed care benchmark and benchmark-equivalent plans; and plans offered through the individual market. Small employers, employers with 50 or fewer employees, remain exempt from the MHPAEA.
Mental health parity laws are based on the premise that insurers should provide similar coverage benefits for mental health treatment as they do for medical and surgical treatment. Historically, insurers have not provided equal coverage to their members for mental health conditions—either by providing no benefits at all, by imposing financial barriers such as through higher copays and deductibles, or by limiting treatment through caps on doctor visits and hospital stays, or through more restrictive annual and lifetime dollar limits on coverage.
Federal Health Parity Laws
Congress took the first step towards mental health parity with the Mental Health Parity Act of 1996 (MHPA). The MHPA mandated parity between mental and physical health services with respect to annual and lifetime and dollar limits on coverage. The following year, Congress extended MHPA requirements to all SCHIP plans and Medicaid managed care plans. The law was extremely limited in scope, however; it only applied to group health plans and contained an exception for small business employers. It also did not compel insurers to provide mental health services. Furthermore, insurers were free to circumnavigate the law altogether by limiting treatment options or through higher cost sharing requirements on mental health services. Finally, Congress undermined the law from its inception by including a sunset provision on the law that had to be extended six times before a new mental health parity law was passed.
Over a dozen attempts were made in Congress after the first Mental Health Parity Act to provide additional parity coverage, but little legislative action was taken until the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA became fully effective in January 2010 and addressed several of the shortcomings in the previous federal mental health parity law. Under the MHPAEA, health insurers and group health plans must guarantee that cost sharing requirements on mental health benefits and limitations on treatment are not more restrictive than requirements and restrictions for medical and surgical benefits. Unfortunately, the MHPAEA did not remedy all of the flaws in the MHPA. Parity protections were still limited to group health plans; like its predecessor, the MHPAEA did not apply to the individual health insurance market. And, like the previous mental health parity law, the MHPAEA in no way mandated that insurers provide mental health benefits, only that if they chose to do so, the plans they offered must comply with the MHPAEA’s parity provisions.
Despite their flaws, these mental health parity laws have helped a substantial number of patients get necessary care, and what is more, have done so at minimal cost to insurers. Actuarial reports and Congressional Budget Office studies of the federal mental health parity laws predicted less than a 1% increase in health insurance premium costs. Research on states’ experiences with parity legislation also consistently found little effect on spending through the implementation of mental health parity laws; in fact, they resulted in a reduction of out-of-pocket expenditures for some states.
The passage of the Patient Protection and Affordable Care Act (PPACA) greatly expands federal requirements for mental health treatment and parity. It establishes, for the first time, federal mandates that mental health services be provided as part of an “Essential Health Benefits” package that individual and small group plans must provide. While the PPACA gives the Secretary of Health & Human Services the ultimate say in what constitutes essential health benefits, HHS’ current interim policy allows states to benchmark its own essential benefits package to one of several existing employer-based insurance plans.
While the exact composition of mandated mental health services will vary from state to state, federal parity requirements will not. The PPACA extends existing federal mental health parity law to cover three main types of plans: qualified health plans available on health insurance exchanges, Medicaid non-managed care benchmark and benchmark-equivalent plans; and plans offered through the individual market. Small employers, employers with 50 or fewer employees, remain exempt from the MHPAEA.