Mental-care shift: Parity
Rules set insurance same as for physical ills
WASHINGTON — Insurers will be required to cover mental illness to the same degree as physical ailments, as President Barack Obama’s administration moves forward with the largest U.S. expansion of behavioral-health care in a generation.
Five years after the Mental Health Parity Act was passed, and almost a year after the Sandy Hook Elementary School shooting in Newtown, Conn., regulations to fully implement the law were released Friday. The new rules mean insurers won’t be able to charge higher co-payments or deductibles for mental illness or limit the duration of care.
Failures in treating mental illness have swelled the workload of police and pushed more emotionally disturbed people into emergency rooms, where they are less likely to get proper care. The new rules expand or protect behavioral-health benefits for more than 60 million people, Kathleen Sebelius, the U.S. health secretary, said at an event in Atlanta.
David Shern, interim president and chief executive ofm
ficer of Mental Health America, a lobbying group based in Alexandria, Va., said, “The parity law, which also applies to policies sold through the exchanges under the Affordable Care Act, is a milestone that recognizes how integral mental health is to overall health and ends discrimination.”
The Obama administration also considers the rules to be a chief component of an effort to reduce gun violence. The White House included improving mental-health services as one of 23 executive actions to combat gun violence after 26 children and adults were killed in the December shooting at Sandy Hook.
“The personal toll for families and individuals is beyond their experience,” Sebelius said Friday. “This is a personal toll that we take on as a country to help people achieve the promise of recovery.”
A common theme in many of the nation’s worst mass shootings is the gunman’s history of mental illness, including in Newtown, as well as massacres at the Washington Navy Yard this year; at an Aurora, Colo., movie theater in 2012; and at the Virginia Tech campus in 2007.
“People with mental illness, they’re far more likely to be victims of a crime than they are to be perpetrators, but we believe the incident [in Newtown] highlighted how much untreated mental illness there is in this country,” Sarah Bianchi, the director of economic and domestic policy for Vice President Joe Biden, said on a conference call with reporters.
Bianchi said the Obama administration has “finished or made significant progress” on all 23 of its post-Newtown promises by issuing the regulation.
The rules issued Friday will provide the most definitive regulatory standard to date for implementing the Mental Health Parity Act of 2008, which then-President George W. Bush signed into law. Bush left office in 2009 without his administration ever writing rules to implement the core part of that law. Obama’s administration issued interim rules in 2010 that still left many aspects of the law open to interpretation.
In January, largely in response to the Newtown shooting, Obama said he would issue final rules this year.
The complexity of the issue, coupled with passage of the Patient Protection and Affordable Care Act in 2010 that included a new set of “essential health benefits” for insurance plans, delayed the final rule on mental illness, one government official said. The person wasn’t authorized to discuss the postponement and asked not to be identified.
“Countless Americans will be safer and healthier because these rules will enable victims of painful and debilitating mental-health conditions to seek treatment before they actually commit harm to others,” Sen. Richard Blumenthal, D-Conn., said on a conference call with reporters. He held a hearing by a subcommittee of the Senate Judiciary Committee on Thursday that questioned the delay.
Patrick Kennedy, the former Democratic congressman from Rhode Island who was a sponsor of the mental-health law, said Friday that the rules could be meaningless unless insurers are forced to obey them.
“The rule really is only as good as the monitoring and enforcement that goes along with it,” he said on the Blumenthal conference call.
The rules apply to almost all health plans in the nation including new ones sold under the health-care overhaul known as Obamacare.