After a 12-year fight led by mental health advocates, patients, families, clinicians, and a handful of members of Congress, some 113 million Americans will soon have equality of coverage between their benefits for physical health care and those for mental or behavioral health care.
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was tucked into the massive financial rescue package passed by the House of Representatives on Oct. 3 and signed into law that day by President Bush.
The biggest victory in the law's passage is “the recognition by the government of the United States that mental illnesses are real illnesses,” said Dr. Nada Stotland, president of the American Psychiatric Association, in an interview.
The law also ensures that substance abuse treatment is specifically subject to the parity requirements.
The law will take effect Oct. 3, 2009, which means that benefit changes should be seen in health insurance policies that take effect in January 2010.
Essentially, the newly enacted law requires companies with more than 50 employees to offer equal coverage for physical and mental health. Theoretically, if the plan offers 30 days of inpatient coverage for cardiac care, then it must offer 30 days of inpatient coverage for a mental health diagnosis. Also, if a plan offers out-of-network coverage for physical health care, it must do the same for mental health care.
However, the law does not outline specifics, such as which mental illnesses or how many visits or how many days should be covered.
That decision is left in the hands of the health plan or benefits administrator—often a self-insured employer.
The law will eliminate the discriminatory copayments, deductibles, and coverage restrictions that previously were used to reduce coverage for mental illness.
The banishing of higher payments will make a big financial difference for patients and families, said APA's Dr. Stotland.
The federal law does not preempt state mandates. The National Alliance on Mental Illness (NAMI) supported that provision, because state mandates often ensure at least basic coverage for the major mental illnesses, Andrew Sperling, director of legislative advocacy for NAMI, said in an interview.
But NAMI expects insurers, health plans, and self-insured employers to continue closely managing mental health care. The law “doesn't mean you get everything you want all the time,” cautioned Mr. Sperling.
Plans also can refuse to pay for care that they deem not “medically necessary,” but they must disclose how they make that determination.