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HEALTH 03-02-10 DM EE E4 BLACK
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KLMNO TUESDAY, MARCH 2, 2010
New rules aid mental health coverage
the New England Journal of Med-
icine in 2006 found that Presi-
dent Bill Clinton’s 1999 parity di-
rective affecting the Federal Em-
ployees Health Benefits Program
improved access to mental health
parity continued from E1 10-year-old parity law in Califor- services without increasing costs.
nia found that nearly half of the The regulations also require in-
most plans Jan. 1, applies to Californians polled did not know surers to explain the criteria used
groups of more than 50 employ- about it. to evaluate or deny a claim, which
ees and is designed to end what Business groups say they are HHS said “must be based on the
Health and Human Services Sec- particularly unhappy that federal same level of scientific evidence
retary Kathleen Sebelius called rules prohibit separate deduct- used by the insurer for medical
“needless and arbitrary limits on ibles for medical and mental and surgical benefits.” Schroeder,
care.” Higher deductibles, steeper health treatment. But most said president of the Mental Health
co-pays and other restrictions are they did not think their members Association of California, said
no longer allowed for mental would drop coverage. that would be particularly helpful
health and substance abuse treat- “I’d say we’re both wary and for consumers and their doctors.
ment. skeptical,” said E. Neil Trautwein, “For many of us, medical neces-
The law does not apply to indi- a vice president of the National sity has been a big black box,” he
vidual insurance policies, nor Retail Federation. “We’re going to said. Schroeder said his insurer
does it require group plans to scrutinize anything” that results once suggested he attend a free
provide mental health and sub- in additional cost. support group instead of therapy,
stance abuse treatment, although Pamela Greenberg, chief exec- and in the past granted permis-
most do. utive officer of the Washington- sion for only three sessions at a
Several weeks ago the Obama based Association for Behavioral time, requiring his therapist to
administration issued 154 pages Health and Wellness, a group “spend an hour on the phone con-
of regulations governing imple- composed of eight companies vincing them that three more vis-
mentation of the law, which was that manage mental health ben- its were medically necessary.”
sponsored by the late Sen. Paul efits for 147 million Americans, Although it is not widespread,
Wellstone (D-Minn.) and former said that prohibiting separate de- advocates say they have received
Sen. Pete V. Domenici (R-N.M.). ductibles may have unintended scattered reports from around
Passed with broad bipartisan
SUSAN BIDDLE FOR THE WASHINGTON POST
consequences. A limited number the country of employers drop-
support and signed into law by of plans, she said, required a low- ping coverage rather than making
President George W. Bush in
Mental health is just as important as physical
er deductible for mental health changes to comply with the law.
2008, the measure is widely re- and substance abuse in an effort Woodman’s Market, a grocery
garded as the last major piece of
health. You don’t have one without the other.”
to persuade more people who store chain that employs 2,800
health legislation passed by Con- need treatment to seek it. people and is based in Janesville,
gress. The rules, which are sub- Denise Camp, who is now paying the same for physical and mental health treatments “You don’t need to do that with Wis., is among them.
ject to a comment period, are arthritis or cancer,” she said. “No “We can’t have an open check-
scheduled to take effect July 1. one’s embarrassed to get help” for book,” company vice president
Officials of key business and in- depression and alcohol abuse. William C. Moyers, a vice presi- Unintended effects? those conditions. Clint Woodman told the Capital
surance industry groups said they “These are serious conditions dent at Hazelden, a network of Federal officials estimate that Greenberg said that it is un- Times in Madison.
were displeased that the regula- that get really expensive really substance abuse treatment cen- complying with the law will in- clear whether companies will de- “If an employee went to a psy-
tions were “more expansive” than quickly,” said Kirsten Beronio, a ters based in Minnesota, says he crease premiums nationwide by cide to “cut back and cover fewer chiatrist and ran up a million dol-
they believe lawmakers intended. vice president of Mental Health hopes the law will encourage four-tenths of 1 percent, or about conditions. That’s not a place we lars, it would come out of our
Mental health advocates ap- America, an advocacy group those who need help to seek it. $25.6 billion over 10 years. Em- want to go.” pockets,” he said.
plauded the rules, which they based in Alexandria. Hazelden, he said, spends $6 mil- ployers are free to drop mental Advocates rejected the view When asked about an employ-
said would help ensure that Some families, she noted, have lion annually providing aid to pa- health and substance abuse cov- that the regulations were oner- ee who incurred similar expenses
Americans battling schizophre- gone bankrupt trying to pay for tients whose insurance covers erage and are allowed to manage ous. Employers and insurers “still after a cancer diagnosis, Wood-
nia, for example, receive the same treatment. In extreme cases, par- only a portion of the cost or runs claims to determine if treatment have enormous tools and leverage man said in the Capital Times:
level of care provided to those fac- ents of troubled children who out after 30 days. Inpatient sub- is medically necessary, just as to control inappropriate” or ex- “Cancer is different. That’s an
ing leukemia. need expensive, intensive ser- stance abuse programs can cost they do now for physical ail- cessive treatment, said Andrew identifiable physical situation.”
“This is a great boon for people vices have been forced to tempo- more than $20,000 per month. ments, but the standards can no Sperling, director of federal legis- Woodman did not respond to
like me who use these benefits,” rarily relinquish custody to the “These are employed, middle- longer be more stringent. Plans lative advocacy for the National several e-mails and telephone
said Peter Schroeder, 36, a com- state so that their children could class people with private insur- are also allowed to exclude treat- Alliance on Mental Illness. calls.
puter scientist in Berkeley, Calif., qualify for services paid by Med- ance,” Moyers said. ment for certain illnesses, such as “Most people don’t go [for But to Camp, the view that psy-
who has received treatment for icaid. eating disorders, as long as state treatment] because this is fun or chiatric treatment is less deserv-
law does not mandate coverage. take psychiatric drugs for recrea- ing is shortsighted. “Mental
There is also an escape hatch: tion,” said Irvin Muszynski, a law- health is just as important as
Plans that can prove that their yer at the American Psychiatric physical health,” she said. “You
costs increased by more than 2 Association. Mental health and don’t have one without the other.”
percent in the first year can file substance abuse expenditures, he health-science@washpost.com
for an exemption. said, account for a fraction of to-
“We are concerned that plans tal health-care expenditures, “so This story was produced through a
are going to try and find ways what is everyone freaking out collaboration between The Post and
around it,” Beronio said. “And about?” Kaiser Health News. KHN is a service
we’re concerned about the lack of Several studies have concluded of the Kaiser Family Foundation, a
awareness in general” about the that parity expands coverage nonpartisan health-care-policy
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