Clinicians Digest Jan/Feb - Page 2


The Impact of the New Parity Bill

Perhaps the greatest value of last October's Wellstone-Domenici Parity Act, which requires many insurance plans that offer a mental health and substance abuse benefit to offer the same level of treatment coverage in those areas that they do for medical procedures, is that it further destigmatizes mental illness. Not only does the bill equalize mental and physical illness, but much of the news surrounding the bill has highlighted the fact that its three primary proponents have been open about their personal struggles with psychological difficulties. Senator Ted Kennedy (D-Mass.) has battled alcohol abuse, Senator Pete Domenici (R-N.M.), has a daughter with schizophrenia, and Representative Patrick Kennedy (D-R.I.) has struggled with depression since adolescence. But the statement by senators Kennedy and Domenici that the bill will "bring dramatic new help to millions of Americans who today are denied needed mental healthcare and treatment" may be overstating the case.

The parity bill represents a significant improvement over the Mental Health Parity Act of 1996, which was renewed through 2008. Like its predecessor, the new bill doesn't mandate that insurance companies pay for mental health, but requires that the deductibles, annual limits, and lifetime limits be equal when mental health benefits are offered. The act  expands the definition of equal coverage for plans that offer mental health benefits to include the same copayments, coinsurance, deductibles, out-of-pocket expenses, and out-of-network coverage for mental health benefits as for medical benefits.

Some restrictions do apply, however. The bill doesn't cover small business and individual insurance plans. It gives state laws governing parity between mental health and medical benefits precedence over the federal bill. That's good news for therapists and clients in some states, such as Washington, which have stronger parity laws than the federal version. But in most states, relatively minor conditions, such as Adjustment Disorder and V-code conditions like relationship problems, are excluded from coverage if the insurer determines they don't meet the standard of "medical necessity." The determination of medical necessity will certainly be a topic of discussion as the act is implemented.

Despite the fact that the new bill covers an estimated 113 million Americans, it isn't likely to have a significant impact on most therapists' incomes. For one thing, as the unemployment figures continue to rise, many more Americans will be losing their insurance. And parity doesn't automatically translate into utilization. Before the Mental Health Parity Act of 1996, the amount spent on inpatient and outpatient mental healthcare was 8 percent of the total spent on healthcare. Since then, the percentage spent on mental health treatment has dropped to about 4.5 percent.

Another reason why the new bill may not help increase therapists' bottom line is that many Americans know that psychiatric claims on their insurance may result in higher premiums, denial of life insurance, or even a denial of coverage if they have to change policies, so they often don't use their insurance for therapy.

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