The Substance Abuse and Mental Health Administration (SAMHSA) has just deployed a website dedicated to advancing and disseminating information concerning the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). http://www.samhsa.gov/healthreform/parity/
The site is loaded with educational and informative sections addressing the laws history and background, its vital importance, and its enforcement. It also casts a bright light for payers, providers and the public into the workings and impact of the law and interim final rule. All of which has come at a very important crossroads for everyone. With the advent of the Affordable Care Act in 2010, reforms are confusing, confounding and frightening providers and the public who lack much of the policy and legal counsel and interpretation payers enjoy. This kind of guidance and direction will help lessen some of the fear and replace uncertainty with confidence.
Moreover, the website comes at a time when the civil rights of people with mental health and substance use disorders continue to be compromised by some health plans and state regulations that lag behind the law in terms of full implementation. It’s still the case, for instance, that many mental health and substance use disorder treatment providers face more stringent medical necessity procedures, processes and strategies. It’s still common for usual, customary and reasonable (UCR) rates of reimbursement to be established inequitably (if not arbitrarily) for mental health and substance use disorder treatment professionals compared to the policies and procedures payers use when developing reimbursement schedules for primary care. It’s also still the case that health plan members are not properly informed of their rights and the manner in which they can now avail themselves of parity in coverage. Recent national surveys reflect that a small minority of health plan members are aware of parity in their coverage.
State Regulations Stalled
It’s been nearly three years since parity & equity (MHPAEA) became law. It’s been many months since the interim final rule was promulgated. And yet, state law and regulations lag behind in many states. While state legislators have been too busy for parity laws and rules (what with having to get acquainted with new governors and dealing with health care reform) providers and the public are left to contend with health plans who are subject only to the oversight of the state department of insurance and insurance commissioner whose responsibility it is to enforce state law and regulations. If that dynamic sounds confusing and fit to fail the people it’s meant to serve, that’s because it is. Until legislators pass state-level parity-compliant laws and state agencies produce rules and regulations, some health plans and managed care organizations are apt to do the wrong thing and punt when pressed for an answer.
Rules are Rules
It’s high time states got busy implementing and enforcing the law. It’s also high time that the Federal agencies responsible for MHPAEA rules promulgated the Final Rule. Delay at the Federal level (understandable considering the task of implementing health care reform) enables states and health plans to play Pass the Buck and the only people left holding the buck are the people who live with these disorders and their treatment providers.
Frankly, it would be a good thing to know we have parity & equity ironed out before having to implement health insurance exchanges and Medicaid expansion – both of which have to comply with MHPAEA and institutionalize Essential Benefits. Where mental health and substance use disorder treatment are concerned, this isn’t only the highest priority, it ought to be considered the only priority until the job is done. Too many other initiatives and concerns – from the Meaningful Use of health information to the integration of behavioral health and primary care – depend upon a clear vision and set of regulatory instructions concerning parity in benefits, coverage, and managed care processes.