Congress is on the verge of passing legislation mandating that health plans cover mental health (MH) and substance abuse treatment to the same extent that they cover other medical and surgical treatment. In a study published December 18 on the Health Affairs Web site, researchers say that passage of either the Senate or House version of this legislation would constitute a major improvement over the current 1996 Mental Health Parity Act, which only guaranteed equal annual and lifetime payment limits. However, the authors also warn that parity legislation could actually reduce access to MH treatment for some patients if it does not facilitate treatment by providers outside insurers’ networks.
The study finds that, in 2005, only a minority of mental health providers in the national capital area participated in networks affiliated with the Federal Employees Health Benefit (FEHB) program, Medicare, Medicaid, or private insurance coverage. Only 38 to 49 percent of the area’s psychiatrists, psychologists, and social workers were members of any network. Participation in FEHB networks was limited to approximately one-third of clinicians, and only 44 percent of FEHB patients received MH care from network clinicians.
“Our study shows that even in an area relatively rich in mental health resources such as Washington, D.C., and its surroundings, plan networks are not equipped to meet the full need for mental health treatment,” said lead author Darrel Regier, executive director of the American Psychiatric Institute for Research and Education (APIRE). “Maintaining the out-of-network option is essential to ensuring access to treatment.”
The version of parity legislation passed by the Senate would allow plans to vary the types of mental disorders covered under parity and to drop out-of-network MH coverage altogether if they decide that offering such benefits is not in their best interest, Regier and his colleagues say. In contrast, the parity bill moving through the House would require plans to cover all mental disorders and to cover out-of-network MH treatment at the same levels as other out-of-network treatment.