As Mental Health Advocates Press for Parity, Insurers and States Want More Time

The federal law to ensure parity in mental health services passed in 2008, but CMS is just now adopting rules for what that means for 21 million Americans in Medicaid managed care.

The quest for parity in mental healthcare has taken years, with advocates pressing insurers and public agencies to move faster, and payers seeking a slower pace. And so it continues, as comments on an April 10, 2015, proposed rule from CMS drew feedback last week from across the spectrum of those involved in mental health or substance abuse issues.

In 2008, the Paul G. Wellstone and Pete Domenici Health Parity and Addiction Equity Act promised a new day in mental health care: group health plans and insurers would be barred from putting higher copayments or harsher limits on behavioral health services than they did on medical and surgical benefits. Two years later, the Affordable Care Act extended these provision to individual plans, making mental healthcare among the “essential health benefits” all Americans would enjoy.

But implementation has been a long road, since such care historically had been walled off from the rest of a health plan, and that’s been no less true in Medicaid managed care, which cares for a disproportionate share of the clients who seek such services. April’s proposed rule seeks to finally spell out what “parity” means for these beneficiaries, whose numbers are estimated at more than 21 million nationwide.

Based on comments submitted to CMS, most of haggling now is over time frames: the proposal calls for states and insurers to have 18 months to comply with the new rules, while many want more time, between 24 and 30 months, according to a report in Modern Healthcare.

Other comments ask whether there’s enough teeth in the proposed regulations to compel states to make sure that health plans have adequate rates to cover the expanded benefits.

Also, the American Academy of Family Physicians (AAFP) weighed in to ensure that the final rules recognize how much behavioral healthcare, especially addiction services, goes on within primary care practices. This happens for a variety of reasons, from shortages of behavioral health specialists to patients who fear stigma from seeking treatment beyond their regular family doctor.

“Family physicians support appropriate public mental health policy and … they promote better mental health services,” said AAFP Board Chair Reid Blackwater, MD. Ensuring that family physicians can receive adequate reimbursement for mental health and addiction services will recognize that these areas are “integral components of family medicine,” the group said in a statement.

Both the AAFP and former US Representative Patrick Kennedy have called for more focus on prevention and advocacy of what he calls “mental health fitness.” In an interview this week with a Boston television station, he said mental healthcare needs to be a priority in the workplace. “Employees are not as productive when they can’t concentrate because they have depression and anxiety,” he told WBZ-TV. Last year, Kennedy spoke about the challenges of implementing mental health parity with The American Journal of Managed Care.

As the CMS rulemaking process plays out, there are signs that Americans are gaining better access to mental healthcare. In its recent report on first-quarter spending, the US Census Bureau found that spending on psychiatric and substance abuse services had gone up 7.9% in the first quarter of 2015 from the same period a year prior, when the first newly insured were gaining access to care under the ACA.