Managed Healthcare Executive - November 2008 - (Page 9)

{ POLITICS AND POLICY } Congress boosts treatment, coverage in mental health Mental health parity law tucked into October nancial bailout bill, hailed as a milestone mental health services to meet the 20% copay it sets for other medical services. INSURERS, EMPLOYERS SIGN ON After years of opposition to more costly mental health mandate proposals, insurers backed this bill as a reasonable compromise. Aetna Chairman Ronald Williams praised the law, saying it was likely to improve health outcomes BY JILL WECHSLER “through integrated medical and behavioral bene ts and services.” An important feature for insurers is fter more than a decade of contentious continued leeway to use bene t management debate, Congress approved legislation strategies in the mental health area, but with last month designed to improve mental more transparency on coverage decisions and health bene ts for individuals participating in denials. Under the law, which takes e ect employer-based group health plans. The law in 2010, insurers that seek to deny payment does not require payers or insurers to cover for care on the grounds that it is not “medimental health treatment. But those health cally necessary” or “clinically appropriate” plans that do so must o er bene ts compamust disclose their criteria for such decisions rable to those for medical conditions such as related to claims for mental health services. cancer or diabetes. Ultimately, insurers are expected to That means no limits on number of doctor integrate mental healthcare with medical and visits and no more copays for psychologisurgical bene ts, based on expanded netcal conditions that are higher than those for works of mental health providers. Already the physical ailments. The list of covered condilegislation is boosting interest in the growing tions was extended to include depression, number of rms providing specialized mental autism, eating disorders and alcohol and drug health bene ts to employers and health plans. Jill Wechsler, a veteran abuse—but not sleep disorders, ca eine inKey to gaining employer support for the reporter, has been toxication or other “fringe” disorders listed in legislation is an exemption for companies with covering Capitol Hill since 1994. a manual issued by the American Psychiatric 50 or fewer employees from the parity requireAssn. and backed by patient advocates. ment. Employers also acknowledge growing The law was hailed as a health policy evidence that treatment of mental health milestone that re ects the declining stigma disorders can improve productivity. against mental illness and scienti c advances At the same time, Helen Darling, president in treatment. Although mental health adof the National Business Group on Health, vocates did not get the coverage mandates warned that over time, requirements such as originally demanded, they acknowledged the mental health parity may erode the ability of importance of the policy in equalizing treatemployers to provide coverage for workers and ment of the mentally ill. their dependents. She advised lawmakers to The new policy is projected to boost health realize that support for this legislation should insurance premiums very slightly—less than not be regarded as opening the door to a “one0.5%. But even that small amount will increase size- ts-all” approach to health reform. tax deductions for premium costs, which will Despite broad enthusiasm for mental health cost the federal government $3.4 billion in lost parity, it remains to be seen if the new requiretax revenue over ve years. Separately, Mediments lead to a reduction in employer health care will move toward parity over six years by bene ts or any narrowing in the range of prodreducing its current 50% copays for outpatient ucts o ered by insurers. MHE A NOVEMBER 2008 9

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Managed Healthcare Executive - November 2008 For Your Benefit Editorial Advisors Contents News Analysis State Report Politics &�Policy Letter of the Law Affordable Access Economic Ripple Effect Hospitals &�Providers Technology Managed Care Outlook Desktop Resource Ad/Edit Index

Managed Healthcare Executive - November 2008

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