Managed Care - April 2008 - (Page 27) chronic conditions.” Parity would enhance plans’ ability to coordinate care, says Un, who has been involved in promoting parity legislation for a number of years. “This is a serious issue,” he says. “Lack of parity and barriers to quality behavioral health care can affect overall health costs.” Un says that in developing the proposed legislation, congressional staffers looked at the FEHB program, which has had behavioral health parity since 2001. They used a study published in the March 30, 2006, issue of the New England Journal of Medicine titled “Behavioral Health Insurance Parity for Federal Employees.” The researchers compared seven FEHB plans from 1999 through 2002 with a matched set of health plans that did not offer parity. They examined the rate of use, total spending, and out-ofpocket spending by users of mental health and substance-abuse services and concluded that “the implementation of parity was associated with significant reductions in out-of-pocket spending in five of seven plans” and “when coupled with management of care, implementation of parity in insurance benefits for behavioral health care can improve insurance protection without increasing total costs.” However, the FEHB study also demonstrates that parity is not a panacea, says Un. “Parity does not necessarily improve access,” he says. “Just because the benefit is available does not mean members will take advantage of it. Case management and other tools would continue to play an important role in the quality of care.” widely. They can be divided into three categories, according to the National Conference of State Legislatures: • Mental health parity or equal coverage laws • Minimum mandated mental health benefit laws • Mandated mental health, known as “offering laws” Laws in 21 states include coverage for substance abuse, alcohol, or drug addiction. Most laws were enacted before 2001. In 2006, New York adopted what is being called “Timothy’s Law,” named for a 12-year-old boy who committed suicide in 2001. It is a prime example of a broad-range parity law, requiring that all private insurance policies have the same deductibles, number of office visits, number of inpatient visits, and copayments for mental health disorders as for other illnesses. Other state parity laws limit the coverage to a specific list of biologically based or serious mental illnesses. Ohio’s law, also passed in 2006, is more limited. Its “Mental Health Parity Act” mandates that coverage provided for seven “biologically based mental illnesses” such as schizophrenia and bipolar disorder be on par with coverage of physical conditions. In July 2007, the North Carolina legislature enacted a measure covering nine conditions. Some states allow discrepancies in the level of benefits provided between mental illnesses and physical illnesses. These discrepancies can be in the form of different visit limits, copayments, deductibles, and annual and lifetime limits. Under socalled mandated-offering laws, such as that in South Carolina passed in 1994, mental health benefits are not mandated. Instead, the option of coverage for mental illness, serious mental illness, substance abuse, or a combination thereof can be provided to the insured. This option of coverage can be accepted or rejected and, if accepted, will usually require an additional or higher premium. (A few mandated-offering laws require that if benefits are offered, then they must be equal.) This variation in laws will not change if Congress does enact federal parity. “We probably would have preferred a law that offered some uniformity across the country, for the sake of administrative simplicity,” says Un. “But this legislation is so important that that does not matter so much.” MC State laws Un and others point to the fact that parity laws have existed at the state level for many years, and a good deal of experience exists to help point the way. Many private market health plans include some type of mental health benefits on a voluntary commercial basis, not necessarily required by state or federal laws. The state laws do not apply to federally funded public programs such as Medicaid, Medicare, or the Veterans Administration. Selffunded health insurance plans, often sponsored by the large employers, are exempt from state regulation because of ERISA. The two laws being considered by Congress do not pre-empt existing state laws. Those laws vary APRIL 2008 / MANAGED CARE 27
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