Insurers directed to treat mental health issues the same as physical ailments

The Obama administration issued a final rule Friday requiring insurers to treat mental health and substance-abuse problems the same way they do physical illnesses.

The rule provides long-awaited clarification on a mental health parity law that was enacted with much fanfare five years ago but had not been fully implemented as the federal government wrote and revised the regulations.

It also represents a fulfillment of a promise made by President Obama, who vowed to put the finishing touches on the regulations as part of a broader effort to address the problem of mass shootings, which have thrust mental health issues into the spotlight in recent years.

“For way too long, the health-care system has openly discriminated against Americans with behavioral health problems. In the past, it was legal for insurance companies to treat these disorders differently than medical and surgical needs,” Health and Human Services Secretary Kathleen Sebelius said in announcing the rule Friday.

Because of the 2008 mental health parity law, as well as the 2010 Affordable Care Act, “we are finally closing these gaps in coverage,” she said.

Mental health advocates lauded Friday’s news because they have been eagerly awaiting final regulations since the passage of the Mental Health Parity and Addiction Equity Act in 2008. Championed more than two decades ago by then-Sens. Paul D. Wellstone (D-Minn.) and Pete V. Domenici (R-N.M.), the law was hailed as a milestone for people with mental illness and substance-abuse problems.

The administration issued interim rules in 2010 meant to partially explain the nuances of the law, but it still left ambiguity in a number of areas, including how insurance companies were to cover the kind of intensive treatment that falls in the gray area between emergency inpatient care and a doctor’s office visit.

Friday’s rule clarifies that people are entitled to information about the standards used by health plans to determine what kind of treatment they cover — information that could be valuable if people want to file a complaint alleging that their mental health service was not treated comparably to a medical one.

It also confirms that the ­gray-area treatments — for example, intensive therapy after a psychotic break that does not require hospitalization — should be covered in a similar fashion as a medical condition, such as the rehabilitation that takes place after a heart attack.

But some mental health advocates said it fell short in at least one respect: It did not indicate that the rules apply to people in private health plans administered through Medicaid, the state-federal program for the poor.

They also noted that five years was a long time to wait for final rules. It was a period in which patients were somewhat reluctant to assert their rights under the law because of the lack of clarity, they said.

Still, they called Friday’s news historic and hailed it as a huge win for people who suffer from behavior problems.

“What a historic day this is, and what a difference it will make to families and individuals who have been discriminated against legally for many, many years,” said Debbie Plotnick, senior director of state policy for Mental Health America, an advocacy group.

By and large, insurance companies have already been abiding by the 2008 law, according to a federal study issued Friday in conjunction with the new rule.

Health plans “have worked to implement these requirements in a manner that is affordable, safe, and effective for patients,” Karen Ignagni, president of industry group America’s Health Insurance Plans, said in a statement Friday. “We appreciate that the final rule enables patients with mental and behavioral health conditions to continue to benefit from the innovative programs and services health plans have pioneered.”

The law applies only to health plans provided by employers with 50 workers or more. The Affordable Care Act, commonly referred to as Obamacare, extended the parity rules to the private health insurance market. The rules do not apply to people in government health insurance programs such as Medicaid or Medicare.

Finalizing the rule had been among the priorities outlined by Obama and Vice President Biden shortly after the attack in December at Sandy Hook Elementary School in Newtown, Conn., where a gunman opened fire, killing 20 first-graders and six school employees before taking his own life.

According to reports, the shooter, Adam Lanza, may have had a history of mental illness. Although studies show that people with mental disorders are more likely to be the victim of a crime than the perpetrator, Newtown and other mass shootings have prompted renewed interest in bolstering the nation’s mental health safety net.

That incident in particular led Obama and Biden to issue a plan to reduce gun violence through 23 proposed executive actions. With Friday’s announcement, all have now been fully or partially implemented.

Sandhya Somashekhar is the social change reporter for the Washington Post.
Juliet Eilperin is The Washington Post's White House bureau chief, covering domestic and foreign policy as well as the culture of 1600 Pennsylvania Avenue. She is the author of two books—one on sharks, and another on Congress, not to be confused with each other—and has worked for the Post since 1998.



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