Parity Regulations in AHCA Give Boost to Mental Health Services

An article in the Milwaukee Journal Sentinel shows how an entrepreneurial approach can   produce a healthy bottom line and increased access to mental health services.  Click here to read “Rising need for mental health care spurs growth in Rogers Behavioral Health System.”

Rogers Behavioral Health System provides care to more than 11,000 people a year, including more than 10,000 in the Milwaukee area.  In the past five years, the system’s revenue has doubled.  It is continuing to expand its services and geographic reach.

Here are key excerpts from the article by Guy Boulton.

“Its recent growth stems partly from changes in federal laws that require health insurers to provide the same benefits for behavioral health as for other medical care.

It also is driven by the increasing acceptance that behavioral health conditions, such as obsessive-compulsive disorder and bipolar disorder, are no different than other medical conditions, such as diabetes or heart disease.

That has helped lessen the stigma long associated with mental illness, resulting in more people seeking treatment. More effective treatments also have contributed to the increase in demand for behavioral health care.”

Although Rogers Behavioral Health had been criticized for treating few patients covered by Medicaid, about one-third of its patients now are funded through Medicaid.   It also helps fill the urgent need for in-patient psychiatric beds.   An average of 500 patients a year are sent to the system when Milwaukee County’s hospital is at capacity.



Parity for Mental Health Services At Risk

The Affordable Health Care Act requires parity in reimbursement for mental health and substance abuse services.  That requirement means that insurance companies must treat mental health and substance abuse problems as the medical conditions that they are.   Patients benefit and the requirement is particularly important in addressing the opioid epidemic.

The Kaiser Health Network listed parity as one of the benefits threatened by substitutions for the ACA.  Read the full article here.


Parity Gets Another Boost from the Federal Government

Federal officials are taking new steps to address unfinished business with the Affordable Health Care Act of 2010.  The AHCA mandated conformity with earlier legislation that requires insurance companies to provide parity between mental health and medical/surgical services and reimbursement for them.

Those in need of mental health services found many obstacles to implementation of the law.   Categorized as “quantitative” issues are higher co-payments and deductibles and shorter periods of coverage for episodes of mental illness.  Among “non-quantitative” problems are prior approval requirements, lack of enough mental health personnel in insurance networks, and lower reimbursement to psychiatrists and other mental health personnel for comparable treatment.

A new guide will help consumers determine if an insurance company has unfairly denied mental health or substance abuse services.  A set of Frequently Asked Questions will also help them understand parity requirements.  Click here for the official report.  Click here for a summary from the Kaiser Health Network.

How Would the Republican and Democratic Nominees Bring about Mental Health Care Reform?

Republican nominee Donald Trump, according to his campaign website, believes that reform is necessary and families need tools to help them with the mental health problems of their loved ones.  He offers few specific proposals except for increased funding to provide services for veterans with PTSD and for suicide prevention.

Trump’s primary goal in terms of health care is repeal of the Affordable Health Care Act, which he would replace with an unspecified improved program.  He proposes making Medicaid a block grant program to offer states greater flexibility in allocating funds by eliminating mandated services.

Democratic nominee Hillary Clinton would host a White House Conference on Mental Health during the first year of her presidency.  Her 12-page plan calls for better enforcement of parity regulations, integration of treatment systems for physical and mental health, improved efforts at early diagnosis and supports for college students, and alternatives to jail whenever possible for those with mental illness.  She would also fund an expansion of community-based housing and employment programs.

Click here for an article with more detail on these proposals.  Clinton’s full plan appears on this blog in the category federal mental health legislation.


Clinton Proposes Comprehensive Plan for Mental Health Reform

Hillary Clinton appears to be getting good advice about reform of the mental health system.  Her recently announced plan includes ideas long advocated by those most familiar with the system’s problems.  Read the full plan here.

Clinton proposes funds for early diagnosis and treatment; better integration of the physical and mental health care systems; enforcement of mental health parity, and providing treatment instead of jail whenever possible. She plans to hold a White House Conference on Mental Health during the first year of her presidency.



Mental Health Gains under Affordable Health Care Act, but Miles to Go

Politico published a good summary of the effects of the Affordable Health Care Act on mental health services.  In short, inpatient services have benefitted, meaning fewer patients are languishing in ERs. Psychiatric hospitals and other institutions are being compensated for the care they provide, meaning they can provide more of it.

Outpatient care, however, remains difficult to access. Parity has been poorly enforced.   An insurance policy does not guarantee access to mental health treatment because of the limited number of psychiatrists and other mental health professionals included in company networks and other obstacles those companies create. Reimbursement rates for Medicaid patients remain low.  Dane County’s Journey, for example, recently announced it could no longer afford to accept Medicaid fee-for-service patients.

Read the full article here.


Journey’s New Director Tackles Funding Problems

For nearly a decade, Journey’s staff have been told to do more with less.  Funding from Dane County has not kept up with inflation or increased demand.  And, “less” is taking  a toll on people in need of mental health services and the staff who provide them.  The agency stopped taking new Medicaid fee-for-service patients this month.  They are the neediest economically of those in search of help.

Journey’s new director Ron Lampert told Wisconsin State Journal reporter David Wahlberg his ideas about how to “grow” a way out of that dilemma.  He will try to persuade the state to increase rates for Medicaid reimbursement, an idea that was echoed by Mary Grabot, director of Adult Mental Health Community Services for Dane County, at a recent meeting about criminal justice reform. See here for full WSJ article.

Lampert should also look at ways to force better implementation of parity laws and regulations.  Although the Affordable Health Care Act requires that mental health services be reimbursed by insurance companies equitably with other health care services, those companies have found ways to evade the law.  See the mental health parity category on this blog.

In the 1980s, a famed psychiatric hospital came up with a method to survive a devastating decline in funds when insurance companies adopted managed care.  The CEO, Steven Sharfstein, embraced business principles that enabled Shepphard Pratt Hospital in Maryland to expand into a multi-service statewide health care system at a time when many psychiatric hospitals were closing.  Sharfstein added new kinds of services, such as special education, that were profitable.  He also persuaded the state to increase Medicaid reimbursement.  See here for more information.

Like Sharfstein, Lampert plans to expand horizontally and geographically by merging with organizations that provide services related to Journey’s core mission, such as job training, and by extending the agency’s reach beyond Dane County.  He also is looking into a more cost-effective and flexible payment system that reimburses at a single rate per person per month.





Join the Battle for Mental Health Parity

With less than a year left of Obama’s presidency, the federal government is beginning to show some determination to implement parity requirements of the Affordable Health Care Act.  On June 10, HHS’s head Sylvia Burwell will host a listening session to learn about problems experienced by practitioners and patients.

You can provide valuable feedback about violations, state enforcement, and support needed for effective implementation.  Click here for an opportunity to sent an email to the National Council for Behavioral Health about your experiences.  The Council will use the information to develop talking points.   Click here to send your comments directly to the President’s Task Force in charge of implementing parity.

Click here for an excellent article by Lloyd Sederer, M.D.,chief medical officer of the New York State Office of Mental Health, offering stories about the human impact when parity is not enforced and examples of how insurance companies evade the law.

Sederer argues for the importance of federal action writing, “Individuals are too overwhelmed and outgunned by insurers to solve the problem, as are doctors.  State insurance agencies are generally very underresourced…legal remedies…are generally too small to attract plaintiff’s attorneys…”

Click here for “Know Your Rights,” a brochure available from SAMHSA that offers simple explanations of the law, common problems and methods of appeal.



Is President’s Support for MH Parity Too Little and Too Late?

On March 29 President Barack Obama announced formation of an interagency task force to promote implementation of the mental health and substance abuse parity provisions in the Affordable Health Care.

As reported in  Kaiser Health News, former Congressman Patrick Kennedy said, “…it’s troubling that it’s occurring in the last year of the presidency, and that it took the administration this long to address a problem that’s been with us for many years.”

LA lawyer Meiram Bendat, who has filed lawsuits on behalf of those seeking treatment, said that “another task force is a far cry from much-needed enforcement.”  He added that “bias against those with mental illness frequently takes the form of insurance companies effectively limiting care only to crisis and refusing to acknowledge the pervasive and long-term nature of these disorders.”

Failure to enforce parity provisions affects all of us. Initially it hurts only a person with mental illness and his or her family members.  But, lack of access to treatment can lead to costly emergency room treatment, loss of earning capability, involvement with the criminal justice system, and more expensive long-term care that is paid by our taxes.





Law Suit Alleging Parity Violations Proceeds to Trial

The New York State Psychiatric Association has cleared an important legal hurdle in its suit against United Health Group and its subsidiaries for systematically violating the federal parity law and the Affordable Care Act.

In August 2015, the U.S. Supreme Court declined to review a lower court decision that held that the association was a proper defendant in the case and held standing to represent the interests of its members and patients.  That decision also held that United could be sued even if it acted only as the administrator of a self-insured plan.

As quoted in Psychiatric News (12/10/2015), Seth Stein, general counsel for NYSPA said, “We hope to expand the scope of the litigation to examine existing disparities in reimbursement between behavioral health benefits and medical-surgical benefits…”See article: