Share this article on:

Equalizing Mental Health Coverage

Potera, Carol

AJN The American Journal of Nursing: February 2014 - Volume 114 - Issue 2 - p 14
doi: 10.1097/01.NAJ.0000443756.15066.a0
In the News

Parity law will bring mental health care into the primary care setting.



The Departments of Labor, Health and Human Services, and the Treasury finalized rules that increase parity in insurance coverage for mental health and substance abuse disorders. Under the Mental Health Parity and Addiction Equity Act, insurance companies must cover these conditions at the same level at which they cover medical and surgical care. Copayments, deductibles, and visit limits for mental health disorders cannot be more severe or restrictive than those for medical and surgical benefits.

Secretary of Health and Human Services Kathleen Sebelius formally released the regulations at the 29th Annual Rosalynn Carter Symposium on Mental Health Policy, held in Atlanta on November 8, 2013. “Nine in 10 Americans with substance abuse disorders do not receive the care they need, and 60% of Americans living with a mental condition do not receive the care they need,” Sebelius said in Atlanta.

Three-quarters of mental illnesses become evident by the time people reach 24 years, and the Affordable Care Act (ACA) allows young adults to stay on their parents’ plan until age 26. These changes allow young people to seek mental health care at a critical time in their lives. Imagine “how different things would be if everyone felt like they could access treatment without the fear of being judged,” said Sebelius, or “if people felt as comfortable saying they were going for counseling as they are [saying they're going] for a flu shot or physical therapy.”

Combined with the ACA, the final parity rule “expands mental health into the primary care setting,” said Carol McDaid, leader of the Parity Now Coalition in Washington, DC, in an interview with AJN. Now that more patients can receive treatment, physicians, nurses, and mental health professionals should feel more comfortable screening patients for depression and addictions. Previously, insurance companies denied mental health coverage or copayments ran 50% or more higher than other copayments, discouraging patients and providers alike. Nurses can help to educate patients on equal coverage and urge them to seek treatment, according to McDaid.

“It was a national disgrace that insurance plans excluded or limited mental health care. Any nurse can tell you that many physical problems are caused or exacerbated by an underlying mental health problem,” Karen Ballard, a member of the American Academy of Nursing's Expert Panel on Psychiatric, Mental Health, and Substance Abuse, told AJN. More advanced practice nurses specializing in mental health and substance abuse will be needed to provide services in primary care practices, community clinics, institutions, and schools and to teach other nurses mental health skills, according to Ballard.

Insurance companies must now reveal the standards they use to evaluate claims, especially when claims are rejected. According to McDaid, if claims are denied patients should appeal. “People must demand their rights under the law.” Consumers and providers needing help can use the tool kit set up by the Parity Implementation Coalition:

Unfortunately, Medicaid and the Children's Health Insurance Program patients aren't yet covered by the new rule, although new regulations are pending.—Carol Potera

© 2014 Lippincott Williams & Wilkins. All rights reserved.