National Nurses United

Mental Parity_Temp 11/24/09 6:53 PM Page 12 those who have coverage, benefits are often insufficient and more costly than physical health visits. Medication coverage is spotty at best and the drugs are expensive. People who need help often can't get it because they simply can't afford it. But a new law aims to shore up one fraying part of it. The Wellstone-Domenici Mental Health Parity and Addiction Equity Act of 2008 was signed into law as part of 2008's economic stimulus plan and it prohibits insurers from discriminating against people like Sharby's children by refusing treatment or charging more for mental health services than physical health services. The law, the result of a dozen years of negotiations, was heralded as landmark legislation and is being used as the foundation for much of the healthcar reform e legislation on the Hill today, say mental health advocates. But like the system it seeks to fix, the law is far from perfect. It is laden with loopholes and exemptions, and may actually make it more attractive for insurers to drop mental health coverage than maintain or expand it. Experts who tracked the process say that intense lobbying by insurers predictably watered down the legislation. Critics of the law say that it might be better than nothing but it , also doesn't address the larger problem of the uninsured, underwriting practices to deny care, and a fragmented healthcare system run for profit. "The brain is the only organ in the body that requires its own insurance policy," said Michael Corbin, director of EveryMinute.org, an advocacy group for increased mental health research. "And it's not necessarily a requirement of insurance companies to include mental health coverage." S harby's children are two of about 26 percent of the U.S. population who have a diagnosable mental disorder in a given year, according to the National Institute of Mental Health at the National Institutes of Health. The most common reason for people to leave their job on disability is major depression. And for those with a mental health issue, it's far more likely that they'll also develop a chemical dependence or substance abuse problem—which can make both mental and physical health problems more difficult to treat. But the way U.S. insurance handles mental health is inconsistent at best, said Corbin, who himself has been diagnosed with rapidcycling bipolar disorder, attention deficit hyperactivity disorder, and generalized anxiety disorder. Corbin's experience is a perfect example of how the insurance system is failing patients. The Nashville native first attempted suicide What the New Mental Health What the New Mental Health Parity Law Does Parity Law Doesn't Do Applies to group insurance plans, including Medicaid managed care plans. Does not apply to the individual market, employers with fewer than 50 employees, Medicaid fee-for-service enrollees, and Medicare. If an insurer offers mental health coverage, requires insurers to provide treatment limits, out-of-network coverage, and other benefits at the same level they do physical health coverage. Does not mandate that insurers offer mental health coverage at all. Allows insurers to determine which mental health conditions it will cover, providing that the insurer complies with state laws. Does not require insurers to cover all diagnoses or conditions. Requires copayments, deductibles, coinsurance, and out-of-pocket expenses for mental healthcare to be the same as for physical healthcare. Does not mandate annual caps or lifetime limits, which are already in place from the 1996 Mental Health Parity Act. Prohibits insurers from limiting the number of inpatient or outpatient mental health visits if it doesn't apply the same limits t physical health visits. o Requires insurers to offer out-of-network coverage for mental healthcare if it provides the same for physical healthcare. Does not require insurers to participate in the law if their costs increase by more than 2 percent the first year or more than 1 percent in subsequent years. The law does not limit underwriting and continues to allow insurers to determine medical necessity by management instead of healthcare providers. 12 REGISTERED NURSE W W W. C A L N U R S E S . O R G OCTOBER 2009

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