Joe Pyle & Benjamin Miller: Empowering Pa. on mental health parity, treatment access
Access to mental health services is elusive for many, and deaths from drug and alcohol misuse and suicide have skyrocketed.
In reality, few individuals with mental health needs get the care they need. Consider that just one in 10 individuals who need substance use treatment accessed such treatment at a specialty facility in 2016. And, the state’s health care system — like the rest of the country — is fragmented, with mental health being seen as a separate and distinct element from physical care.
No one argues about the need to cover and improve access to mental health services. Yet, mental health parity laws — those which require insurers to cover mental health issues, such as depression or substance use disorders, at the same level as illnesses of the body , such as chronic or infectious diseases — remain incredibly weak for almost every state.
In a recent analysis, 32 states received failing grades on enforcing parity. Pennsylvania scored 55 out of 100.
Strong state statutes enforcing parity laws are one of the critical foundations for helping end discrimination in the coverage of mental health and substance use disorder services and changing the culture of what people can expect from health care.
Without robust parity laws and their enforcement, it’s basically a lottery as to what type of care a person might get. There is little accountability around enforcement and seemingly no transparency as to what insurance plans offer for medical and mental health benefits. Patients, providers and policymakers often do not know whether a health plan complies with the parity law and what to expect from health benefits.
While Pennsylvania’s overall score was low, there are bright spots. The state is a leader when it comes to publishing consumer-related information like the Pennsylvania Insurance Department’s Consumer Guide to Private Health Insurance Coverage for Mental Health and Substance Use Disorder Treatment .
In addition to empowering consumers, policymakers in Pennsylvania can take a number of steps to improve parity and help ensure people have proper coverage for mental health and substance use disorders.
1. Mental health conditions must be recognized as broadly as “physical” health conditions. This will ensure the full gamut of mental health conditions are covered as comprehensively as physical diagnoses.
2. Co-pays and out-of-pocket costs must be the same for mental health services as they are for physical health services. As such, states should require that benefit management processes and treatment limitations are no more restrictive than similar limitations for physical health benefits. Mental health services must also have the same coverage limits as services for the treatment of physical ailments.
3. Enforcement and compliance activities should be strengthened by empowering regulatory agencies to enforce parity laws , including the Federal Parity Law . In addition, states should require monitoring agencies to regularly report on steps taken to enforce compliance and mandate that all health benefit plans submit regular analyses demonstrating compliance with the law.
4. Parity enforcement efforts must be increased, and oversight mechanisms updated, through intensive compliance verifications and reviews of consumer complaints and by requiring health plans to submit detailed compliance analyses and compelling plans to come into compliance.
5. Pennsylvania should designate a lead for parity with the commensurate resources to regulate and enforce parity laws and hire and fund consumer advocate offices and other experts who can help patients understand, file and process parity claims and appeals.
Parity remains elusive for many. People are being denied care and have few resources to advocate on their own behalf. It’s time to right a wrong — to see mental health for what it is: an essential and core component to health and well-being.
We cannot afford to sit idly by as decades pass. People need comprehensive mental health coverage and care. Now.