Celebrating mental health parity! Mental health parity bill passes through legislation: this has been a historically momentous year for mental health coverage as the legislature achieved passage of a landmark law to bring mental health parity protection to more than 100 million Americans covered by group health insurance.
Article Type: Interview
Subject: Mental health (Laws, regulations and rules)
Americans (Insurance)
Health insurance (Laws, regulations and rules)
Pub Date: 12/22/2008
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2008 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Winter, 2008 Source Volume: 11 Source Issue: 4
Topic: Event Code: 930 Government regulation; 940 Government regulation (cont); 980 Legal issues & crime; 250 Financial management Advertising Code: 94 Legal/Government Regulation Computer Subject: Government regulation
Product: Product Code: 6322000 Medical Care Insurance; 6320000 Accident & Health Insurance NAICS Code: 524114 Direct Health and Medical Insurance Carriers; 5241 Insurance Carriers SIC Code: 6324 Hospital and medical service plans
Persons: Named Person: Stalters, Linda Whitten
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 192800787
Full Text: Simply put, parity means equality. For many years, therapists and other mental health professionals have lobbied to place mental health coverage on a level playing field with physical health coverage. Although there are obvious differences between life-threatening physical illnesses such as cancer and mental illness, it has been proven time and time again that mental illness and addictions can be just as damaging. The American Psychotherapy Association recently conducted an interview with our Washington D.C. Liaison and member Linda Whitten Stalters, who lobbied for mental health parity.

1. This is an enormous milestone for the mental health field. What does this legislation mean for Americans?

This has been a historically momentous year for mental health coverage as the legislature achieved passage of a landmark law to bring mental health parity protection to more than 100 million Americans covered by group health insurance. Passage of the Mental Health Parity and Addiction Equity Act is a comprehensive parity legislation. This legislation applies to all group health plans with 51 or more employees, 82 million individuals in self-insured employer health plans that are not governed by state parity laws, and another 31 million in plans that are subject to state regulation.

Except to the extent that a state parity law requires broader coverage, the legislation imposes no requirements as to what conditions must be covered, and whatever is covered must be at parity with medical coverage, it prohibits group health plans that offer coverage for mental health and substance use conditions from imposing treatment limitations and financial requirements on those benefits that are stricter than for medical and surgical benefits. It covers the full range of mental illnesses, including major depression, bipolar disorder (manic-depression), schizophrenia, and anxiety disorders, and it will strengthen the 1996 law by prohibiting unequal limits on annual or lifetime mental health benefits, inpatient hospital stays, outpatient visits, and out-of-pocket expenses.


A plan offering out-of-network benefits for medical/ surgical care must also offer out-of-network coverage for mental health and addiction treatment and provide services at parity.

This legislation preserves strong state parity and consumer laws. State parity laws vary widely from state to state.

Mental Health America provides a great overview of States' Parity: http://takeaction.mentalhealthamerica.net/ site/DocServer/Parity_Chart_2008_l_.pdf?docID=1161

2. Will the inclusion of mental health services raise insurance premiums?

The Congressional Budget Office (CBO) has estimated that the Act will raise health plan premiums by an average of about 0.4 percent, to be split between employers and their employees Cost exemption allows a health plan to be exempted from the federal parity law if it can prove that parity is raising its total plan costs by more than 2% in the first year after enactment of parity law and 1% thereafter. Plans must first implement parity for at least 6 months.

This legislature eliminates the higher out-of-pocket costs for mental health treatment than other illnesses, thus it can potentially reduce out-of-pocket costs.

3. Who will likely benefit from this? Who will not benefit?

As cited previously, this benefits employees enrolled in group health plans with 51 or more employees. Children and adults with a mental illness (brain disease/disorder) will benefit. Employers whose overall productivity is adversely affected by untreated mental illness will benefit.

4. Is this fight now over? Are there any other obstacles that still stand in the way of complete parity?

Appropriately implementing this legislature will take time. The law is to be implemented by January 2010.

The new Administration and Congress must be kept aware of the priority for mental health treatment. We must continue to educate our legislators. It has been my experience that mental (brain) illness is widely misunderstood. One legislator remarked, "We can't increase mental health coverage because mental illness is more frequently being diagnosed." My retort is, "When other diseases are more frequently diagnosed, do we stop treating the newly diagnosed?"

This legislation only addresses employee group health insurance of a workforce of 51 employees or more. The Medicare Improvements for Patients and Providers Act of 2008, another crucial legislative victory toward ending discrimination against people with mental health needs, was passed July 15th of this year. The legislation will phase out the inequitable 50 percent co-pay requirement for outpatient mental health care under the Medicare program. This longstanding discriminatory practice has helped to maintain stigma.

These are breakthroughs but not an end. We can look forward to the day when people with mental health (brain) conditions are viewed as no different than people with any other health condition.

Mental Health Legislature in the Works

Summaries written by the Congressional Research Service:

Community Mental Health Services Improvement Act (S. 2182) and Community-Based Mental Health Infrastructure Improvement Act (S. 2183) 10/17/2007--Introduced

Community Mental Health Services Improvement Act--Amends the Public Health Service Act to require the Secretary of Health and Human Services to award grants for: (1) services to children, adults, and older adults with mental illnesses who have co-occurring primary care conditions and chronic diseases through the co-location of primary and specialty medical care in community-based mental and behavioral health settings; (2) programs to address behavioral and mental health workforce needs in professional shortage areas; (3) expanding behavioral and mental health education and training programs; (4) tele-mental health in medically underserved areas; and (5) developing and implementing a plan to ensure that the National Health Information Infrastructure meets the needs of mental health and substance abuse providers.


Community-Based Mental Health Infrastructure Improvements Act--Amends the Public Health Service Act to authorize the Secretary of Health and Human Services to award grants to eligible entities for the construction or modernization of facilities to provide mental health and behavioral health services to individuals. Defines an "eligible entity" as: (1) a state that is the recipient of a Community Mental Health Services Block Grant and a Substance Abuse Prevention and Treatment Block Grant under such Act; or (2) an Indian tribe or a tribal organization.

* Includes among grant application requirements assurances that facilities will be used for not less than 10 years for community-based mental health or substance abuse services for those who cannot pay for such services. Permits a grant recipient to request permission to transfer such a 10-year obligation to another facility.

* Authorizes a state that receives a grant to award a subgrant to a qualified community program for activities such as: (1) the construction, expansion, and modernization of mental and behavioral health facilities; and (2) the construction and structural modification of facilities to permit the integrated delivery of behavioral health and primary care of specialty medical services to individuals with co-occurring mental illnesses and chronic medical or surgical diseases at a single service site.

* Requires a grant recipient to agree to make available nonfederal contributions matching federal funds provided.

MHLG Supporting Letter(s) Excerpts

This legislation is vital to the health and well being of people with mental illness, as evidenced in a 2006 report developed by the Medical Directors Council of the National Association of State Mental Health Program Directors (NASMHPD). Their report found that people with mental illnesses seem to have the shortest life expectancy and the highest levels of disability among any other subgroup in all of American public health. For this reason, we are particularly pleased with the inclusion of provisions that would co-locate primary care, specialty medical care, and substance use treatment services in Community Mental Health Organizations throughout the United States. In addition, your legislation would appropriate much-needed funding to support the construction or modernization of facilities used to provide mental health and behavioral health services.

Since the President's New Freedom Commission Report referred to a "workforce crisis" in the mental health and substance abuse field, we also support the personnel preparation initiatives contained in these bills. Both the new university-based training programs as well as additional student loan assistance will help community mental health programs operating in health professional shortage areas. In addition, the new tele-mental health and health information technology programs contained in your legislation will help address the twin goals of improving the quality of care and expanding access to behavioral health services in rural areas.

H.R. 6375 and S. 3195 Healthy Transition Act of 2008

This bill is in the first step in the legislative process. Introduced bills go first to committees that deliberate, investigate, and revise them before they go to general debate. The majority of bills never make it out of committee. Keep in mind that sometimes the text of one bill is incorporated into another bill, and in those cases the original bill, as it would appear here, would seem to be abandoned. [Last Updated: Sept. 27, 2008]


Healthy Transition Act of 2008--Amends the Public Health Service Act to require the Secretary of Health and Human Services to award grants or cooperative agreements to states: (1) to develop plans for the statewide coordination of services to assist adolescents and young adults with serious mental health disorders in acquiring the skills, knowledge, and resources necessary to ensure their healthy transition to successful adult roles and responsibilities; and (2) for the coordination of such services.

* Requires the Secretary to designate a federal entity, or establish a Committee of Federal Partners, to coordinate programs providing such services.

* Directs such entity or committee to: (1) review how federal programs and efforts that address issues related to the transition of adolescents and young adults with serious mental health disorders may be coordinated to ensure the maximum benefit for the individuals being served; and (2) provide technical assistance to the states who are planning or implementing programs under this Act.

Excerpts from MHLG supporting letter(s) for The Healthy Transitions Act, H.R. 6375/S. 3195

According to the Government Accountability Office, an estimated 2.4 million youth within transition ages (18 to 26) have serious mental health disorders. Although this population is not unique in experiencing difficulties as they transition to adulthood, they are more likely than their peers to experience poor outcomes, including areas of employment and education. Left without access to necessary services and supports, successful transitions to adulthood cannot be realized. The Healthy Transitions Act would help young adults with serious mental health disorders obtain vital resources, knowledge, and skills necessary for adulthood.

The Healthy Transitions Act would establish planning and implementation grants to states to assist in the development of a coordinated service delivery system to maximize continuity of care and access to services. Young adults who are transitioning to the adult mental health system will be able to benefit from the infrastructure that would be developed to access such services as peer support programs, independent living and life support skills, as well as employment, housing, and education supports. Additionally, H.R. 6375 [S.3195] would establish a committee of federal partners to help coordinate the myriad of federal programs that assist young adults with mental disorders and provide technical assistance to states as they implement their plans.

Reauthorization of the Juvenile Justice and Deliquency Prevention (JJDPA), S. 3155 6/18/2008--Introduced

Juvenile Justice and Delinquency Prevention Reauthorization Act of 2008--Amends the Juvenile Justice and Delinquency Prevention Act of 1974 (Act) to reauthorize through FY2013 the juvenile delinquency prevention programs of such Act.

* Requires the Administrator of the Office of Juvenile Justice and Delinquency Prevention (Office) to include in the annual report of the Office information on juveniles held in state and local secure detention and correctional facilities, the treatment of status offenders (e.g., runaways, truants), and evidence-based programs for juvenile delinquency prevention.

* Expands requirements for state plans under the Act to require: (1) statewide compliance with the core requirement of the Act for protection of incarcerated juveniles; (2) alternatives to detention for juveniles who are status or first-time minor offenders; (3) use of community-based services to address the needs of at-risk youth; (4) programs to improve the recruitment, selection, training, and retention of professionals working in juvenile delinquency prevention programs; and (5) the identification of racial and ethnic disparities among juveniles in the juvenile justice system.

* Authorizes the Administrator to make incentive grants to state and local governments for juvenile delinquency prevention programs, including evidence-based programs for the prevention and reduction of juvenile delinquency, personnel recruitment and training, and mental health and substance abuse screening and treatment.

* Includes mentoring programs as a permissible grant purpose under the Incentive Grant Program for Local Delinquency Prevention.

* Reauthorizes such grant program through FY2013.

Excerpts from MHLG Letter of Support

We strongly urge you to improve and expand upon provisions in S. 3155 that would significantly help address the shameful plight of too many young people with mental disorders intersecting with the juvenile justice system. In fact, studies have shown that 70 percent of youth in the juvenile justice system have a diagnosable mental health disorder. Clearly, given this alarming statistic, decreasing this significant prevalence and appropriately reducing juvenile crime is a priority, and the reauthorization of the Juvenile Justice and Delinquency Prevention Act is the right opportunity to undertake this work.

We urge you to build upon S. 3155 by including a set of mental-health-specific improvements....

Specifically, we urge you to consider adding four provisions:

* Establish grants for partnerships between state and local juvenile justice agencies and state and local mental health authorities (or appropriate children service agencies) for diversion and treatment programs

* Establish grants to provide training to individuals involved in making decisions regarding the disposition of cases involving youth who enter the juvenile justice system

* Establish grants to develop comprehensive collaborative plans to address the service needs of juveniles with mental health or substance abuse disorders who come into contact with the justice system or who are at risk of coming into contact with the justice system

* Establish a Protection and Advocacy (P&A) program to monitor conditions of confinement (in facilities where youth with disabilities are incarcerated) and compliance with the core protections of the JJDPA

Mental Health on Campus Improvement Act (S. 3311)

Full Text: http://www.govtrack.us/congress/ billtext.xpd?bill=s110-3311

MHLG Letter of Support Excerpts

In the 2006 National College Health Assessment, 43.8% of the 94,806 college students surveyed reported that during the past year they "felt so depressed it was difficult to function." Additionally, one out of every 11 students stated that they had "seriously considered suicide at some point during the previous year." Students also named depression as one of the top 10 impediments to academic performance. Unfortunately, many colleges and universities are ill-equipped to address the mental health needs of their communities. The 2007 National Survey of Counseling Center Directors found that the average ratio of counselors to students on campus is nearly 1 to 2000, the recommended ratio being 1 to 1000.

To address such troubling figures, S. 3311 aims to maximize the likelihood that students who require mental health treatment receive it and to ensure that their problems not reach crisis proportions before services become available. To achieve this, the bill establishes grants to eligible colleges and universities to foster a comprehensive approach to campus behavioral health issues, including promotion of mental health; prevention of behavioral health disorders; expanding campus mental health services and mental health training, education, and outreach; and developing and disseminating best practices to other colleges and universities.

The legislation also calls for the establishment of a national public education campaign, focusing upon mental and behavioral health on college campuses. Such a campaign would assist in improving the understanding of mental health and mental disorders and serve to encourage help-seeking behaviors.

As the new Administration and Legislative bodies will be challenged with health-care issues, it is imperative that we educate and assure that mental health care will secure an equitable position.

APA's Involvement

Over the past 6 years, the American Psychotherapy Association has played an active part in lobbying with congressional leaders to contribute to the efforts to forward the Mental Health Parity Law. Dr. Robert O'Block, with the staff of the American Psychotherapy Association, has formed coalitions with several lawmakers and activist groups to promote the needs of our members.

We continue to pledge our dedication and effort to promote and speak out on behalf of our membership.


The law:

* Generally requires parity of mental health benefits with medical/ surgical benefits with respect to the application of aggregate lifetime and annual dollar limits under a group health plan

* Provides that employers retain discretion regarding the extent and scope of mental health benefits offered to workers and their families (including cost sharing, limits on numbers of visits or clays of coverage, and requirements relating to medical necessity)

The law also contains the following two exemptions:

Small employer exemption--MHPA does not apply to any group health plan or coverage of any employer who employed an average of between 2 and 50 employees on business days during the preceding calendar year, and who employs at least 2 employees on the first day of the plan year.

Increased cost exemption--MHPA does not apply to a group health plan or group health insurance coverage if the application of the parity provisions results in an increase in the cost under the plan or coverage of at least one percent.

Fact sheet: The mental health parity act. (2008). U.S. Department of Labor Employee Benefits Security Administration. Retrieved November 25, 2008, from http://www.dol.gov/ebsa/newsroom/ fsmhparity.htrnl

Linda Whitten Stalters, APRN, BC, FAPA, is Chair of the Board of Directors of the Schizophrenia and Related Disorders Alliance of America (SARDAA). SARDAA was organized to continue ongoing support for Schizophrenics Anonymous, create a national toll-free hotline, provide information via its Web site (www. sardaa.org), promote personal stories of recovery and hope, and organize a speaker's bureau of people with expertise about living with the disease, family issues and care professionals. SARDAA's focus is on providing materials and information that will assist people in their own personal journey in living with their illness.

Contact Linda Whitten Stalters at linda.stalters@sardaa.org.
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