About 25% of health plans in two state-run public exchanges were found to violate the federal mental health parity law, according to research by the Johns Hopkins Bloomberg School of Public Health that was published in the journal Psychiatric Services.
At issue were significant cost differences for medical-surgical and behavioral health benefits, as well as tougher prior-authorizations requirements for the latter category. The researchers suggested a need for better regulation and more monitoring of potential discrepancies in benefits.
But these findings may not represent any cause for alarm. Apart from the studys limited scope, an insurance industry insider questioned its methodology, which included an examination of benefit brochures for a large and smaller state exchange during the first HIX open-enrollment period. Neither state was named by researchers, who chose them based on a variety of plan choices and necessary documentation that was easily accessible.
Its nearly impossible to say a plan is not in compliance if you are just looking at the summary of benefits and coverage, Clare Krusing, a spokeswoman with Americas Health Insurance plans told USA Today. You have to look at the claims history to make sure its at parity.
Even one of the researchers admits that additional work is needed. A more comprehensive study is certainly warranted to see if this is a systematic problem beyond these two states and, to the extent it is, steps need to be taken where there are apparent violations of the law, Kelsey N. Berry, a Ph.D. candidate at Harvard University, said in a statement.
Still, enough concern has been raised across the industry to justify deeper examination of this issue. For example, the National Alliance on Mental Illness concluded earlier this year that health insurance plans are falling short in coverage of mental health and substance abuse conditions. The nonprofit group noted that health plan members told pollsters they were twice as likely to have treatment for mental health denied than physical care.
Carol McDaid, an advocate who runs the Parity Implementation Coalition, has noticed slow implementation and enforcement of the law in both state and federal exchanges, as well as the general commercially insured and self-funded plans.
State regulators may be taking note. NPR reports that a handful of states, including New York and California, have sought enforcement actions that include settlements with insurance companies amid a flurry of individual and class-action lawsuits that allege violations in mental health and substance abuse parity law.
At the heart of the federal mental parity law, lawmakers were seeking to bring into focus the importance of treating peoples physical health alongside their mental health in parity, adds Jon Comola, co-founder of World Wide Wellbeing, whose commitment to creating the worlds healthiest countries is built around advancing physical, mental and fiscal well-being. This harmony is consistent with the ideals of our company, which is enabling each person to be all they can be.
The Psychiatric Services study found a greater level of plan compliance in the larger state than the smaller state, where violations of the parity law were found in more than half of the plans being offered. While visits to a general practitioner required a specific copayment, such as $10, the researchers noted that mental health visits were based on a percentage of the cost thats typically much higher than the medical-surgical copay.
Parity law violations identified in the two states studied suggest that they may manifest in patterns that vary from state to state, according to a news release announcing the findings. Moreover, the researchers said discrepancies were documented in plan brochures and not considered isolated instances.
Elsewhere in the HIX marketplace, efforts are under way to close any care gaps. Evergreen Health, a Maryland-based consumer operated and oriented plan known as a CO-OP and funded by the federal government under the Affordable Care Act, has gone where few other health plans have dared to go. It is taking a collaborative approach that fully integrates behavioral health with primary care for more meaningful results.
In the final analysis, Comola says its important to recognize the mental and physical well-being arent mutually exclusive, adding that the head is inseparable from the body, and that truth we should never violate.
Favoring physical over mental health treatments invariably will undermine healthy outcomes, notes Larry McNeely, policy director for the National Coalition on Health Care. He explains that its borne out by some of the integrated models, particularly for high-cost beneficiaries, whereby a failure to provide certain behavioral health services makes it much harder to manage both quality and cost for chronic conditions.
Our health care system has suffered for a long time from this bifurcated sense of everything that falls between ones ears and above your neck isnt health care; its somehow something different, he says.
McNeely sees growing pains associated with moving to a system that really does look at mental health and physical in the same way. Closing gaps in physical and mental health benefits coverage is a bipartisan, nonpartisan decision that will be critical in dealing with everyones health care outcomes and costs, he says.
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