|Secretary of Health and Human Services Kathleen Sebelius talks about the Affordable Care Act at theSouthside Medical Center in Atlanta on Friday, Nov. 8, 2013. She was in town to discuss enrollment options available to Georgia residents. (Kent D. Johnson/Atlanta Journal-Constitution/MCT)|
Youths suffering from mental illness or substance abuse will be more likely to receive the treatment they need as a result of a new federal rule, experts say.
The rule, unveiled Friday by the Obama administration, requires insurers to offer parity between coverage for mental illness and substance abuse and other medical or surgical treatment.
“This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans,” Health and Human Services Secretary Kathleen Sebelius said, announcing implementation of the long-delayed 2008 Mental Health Parity and Addiction Equity Act.
In January, the administration had committed to finalizing the rule as part of its effort to reduce gun violence.
The new rule implementing the parity law requires that features of health insurance plans such as co-pays, deductibles and limits on the number of visits are generally not more restrictive for mental health and substance abuse than they are for other medical or surgical benefits.
The law, which applies to health plans provided by employers with 50 workers or more, doesn’t require insurance companies to offer mental health and substance abuse coverage but requires parity with medical/surgical coverage for those that do.
Parity should lead to more youths receiving coverage, experts said.
“We do know that there are many, many young people who have some type of mental health or substance use conditions that don’t get into treatment so … this would be very important to support their ability to get treatment,” said Suzanne Fields, a senior adviser for health care financing at the Substance Abuse and Mental Health Services Administration.
Fields said young people have often been frustrated by barriers to treatment, and said it’d now be “much easier to get access” to mental health and substance abuse coverage because of the parity rule.
She also noted that the law requires more transparency, as standards for medical necessity determinations and reasons for denying mental health or substance abuse benefits must be disclosed upon request.
Wendy Brennan, executive director of the National Alliance on Mental Illness-NYC Metro, noted one in five children will have a mental health disorder in any given year and one in 10 will experience a serious emotional disturbance.
“When you hear about this law being passed that puts mental health on par with physical health, I think this changes people’s attitudes,” Brennan said. “I think it makes it more likely that a parent will seeks treatment for their child.
“This [law] is absolutely a step in the right direction. This is just a terrific thing,” Brennan said. “When you have an equal framework that sets mental and physical health on par with each other, you’ve come a long way. This is a huge step forward, and it will make a difference to a lot of families.”
Brennan also said the law would reduce stigma surrounding mental illness that sometimes prevents people from seeking coverage and makes it difficult to find quality treatment when they do seek it.
But she said barriers to coverage remain.
She noted there’s a “significant shortage” of child psychiatrists and said in managed-care networks, the in-network providers often don’t take insurance, particularly for children.
Brennan also expressed doubts there will be enough funds for enforcement of the law, and said insurance companies might rely on cost-control mechanisms more on the mental health side than they do on the physical health side.