Managed Care - April 2008 - (Page 15) tal health and substance abuse benefits. • Plans are prevented from placing more stringent treatment limits, such as frequency-oftreatment and lifetime spending caps, on mental health and substance abuse treatment benefits than they do for other care. For example, typical annual limits now include 30 visits to a doctor or 30 days of hospital care for treatment of a mental disorder or substance abuse. Such limits would no longer be allowed if the insurer had no limits on treatment of conditions like cancer, heart disease, and diabetes. • The law will apply to group insurance and employer plans with 50 employees or more. It would have cost-increase exemptions that would waive the parity agreement for one year for plans in which premiums would rise more than 2 percent as a result of complying with the bill. One area where the two versions differ is that under the House version, which passed in March and is titled the Paul Wellstone Mental Health and Addiction Equity Act of 2007, after the deceased senator who long favored parity, health plans that provide mental health benefits would face new requirements to cover all mental and substance-abuse disorders listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. The idea, according to the bill’s House sponsors, APPROACH TO MENTAL HEALTH COVERAGE EVOLVES As Congress debates parity legislation for mental health and substance abuse treatment, more spending is moving into the public sector and more money is being spent on drugs and insurance administration. Estimated mental health spending for 2003 and 2007 by setting and payer Annual growth rate (Total % change from 1986 to 2003) Total mental health care spending By setting Outpatient Retail prescription drug Inpatient Residential Insurance administration By payer Total private payers Private insurance Out of pocket Other private Total public payers Medicaid Other state and local Medicare Other federal 0 $20 $40 $60 $80 $100 $120 Source: National Expenditures for Mental Health Services and Substance Abuse Treatment, 1993–2003, SAMHSA pub. (www. samshsa.gov) and Open Minds (www.openminds.com) 6.7% 7.5% 14.9% 2003 (billions) Estimated 2007 spending (billions) 3.5% 4.7% 9.3% 6.1% 7.5% 5.2% 2.3% 7.3% 9.9% 5.5% 8.2% 3.2% $140 APRIL 2008 / MANAGED CARE 15 http://www.samshsa.gov http://www.openminds.com
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