Parity and Mental Health Coverage

Position Statement

NAMI Indiana seeks and promotes equal access to services and benefits for people living with mental illness, in both the private and public sectors.

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What should I do if I suspect a parity violation?

              1. Review the Parity Resource Guide by the Kennedy Forum and/or Community Catalyst's Guidance for Advocates to strengthen your understanding of the federal parity law and the appeals process. This will help you argue your case!
              2. Appeal with your health plan (if applicable).
              3. If the internal appeal is denied, file a complaint with the appropriate regulatory agency.
  • Private group plans (or fully insured plans) --- These are health plans that your employer purchases from insurance carriers as a benefit for their employees. You may have to ask your employer if their health plan is fully insured or self-insured.
  • Plans purchased through federal Health Insurance Marketplace (healthcare.gov) --- These are health plans you can purchase for yourself and/or your family if you do not have insurance available to you through other means.
  • Self-funded plans (or self insured plans) --- These are health plans that employers or unions create just for their employees or members. You may have to ask your employer if their health plan is fully insured or self-insured.
  • Indiana Medicaid (Health Indiana Plan / HIP, Hoosier Healthwise, Hoosier Care Connect, Fee for Service) --- These are health programs that the state issues to low-income Hoosiers. If your Medicaid is provided by a managed care company (i.e. Anthem, MDWsie, MHS), you should file an appeal with them before you file a complaint with OMPP. This guide is useful in navigating the appeals process.

(external resources can be found at the end of this page)

History

1996 - Mental Health Parity Act of 1996 is passed.

2008 - Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 is passed. This builds upon the 1996 Mental Health Parity Act. MHPAEA requires group health plans and insurers that choose to offer mental health and substance disorder benefits, to do so at parity with medical and surgical benefits.

2010 - MHPAEA becomes effective. The Patient Protection and Affordable Care Act is passed, which, over the coming years, will open the door to health coverage for many uninsured Americans.

2013 - MHPAEA final regulations are (finally!) issued by HHS.

2014 - As a result of the ACA, small group and individual market plans are required to meet "essential benefits" guidelines, which includes mental health and substance abuse services. Prior to this, only health plans that chose to offer mental health and/or substance abuse services had to offer them at parity with medical and surgical benefits (all or nothing).

2015 - Indiana expands the Healthy Indiana Plan (Indiana's Medicaid program), which could potentially cover 350,000 otherwise uninsured Hoosiers. All newly covered individuals will have mental health and substance disorder coverage at parity with their medical and surgical benefits.

Media

Patrick Kennedy: Mental health needs equal treatment - Joseph Dits, South Bend Tribune (10/8/2015)

SOUTH BEND — General physician. Obstetrician. It doesn't matter what kind of doctor you're seeing. "I'd like to see a checkup from the neck up," said Patrick Kennedy, the youngest son of the late Sen. Ted Kennedy. "You can't treat diabetes and ignore depression and anxiety."

The junior Kennedy walked the stage Wednesday as he spoke to a luncheon crowd at the Palais Royale with all of the passion of a Kennedy.

"Forget stigma," he said. "Let's end discrimination against people with mental illness. Because we're not going to change everyone's minds overnight."

Kennedy himself has struggled with bipolar issues since he was a teenager and with addictions that persisted while he was a U.S. representative for Rhode Island, even while he sponsored the Mental Health Parity and Addiction Equity Act, a bill that passed in 2008 to guarantee equal access to mental health and addiction services.

Kennedy is now on a crusade to see that the act is enforced: specifically, to ensure that patients gain mental care just as easily as they gain treatment for cancer and other physical ailments...

(read the full article here)

Is mental health 'parity' law fulfilling its promise? - Jenny Gold, Kaiser Health Network (9/20/2015)

When Michael Kamins opened the letter from his insurer, he was enraged.

His 20-year old son recently had been hospitalized twice with bipolar disorder and rescued from the brink of suicide, he said. Now, the insurer said he had improved and it was no longer medically necessary for the young man to see his psychiatrist two times a week. The company would pay for two visits per month.

"There was steam coming out of my ears," Kamins recalled, his face reddening at the memory of that day in June 2012. "This is my kid's life!"

His son again became suicidal and violent, causing him to be rehospitalized eight months later, said Kamins, a marketing professor at the State University of New York, Stony Brook. Kamins is suing the insurer, OptumHealth Behavioral Solutions, which disputes his version of events and denies that it left the young man without sufficient care.

Seven years after Congress passed a landmark law banning discrimination in the treatment of mentally ill people, many families and their advocates complain it stubbornly persists, largely because insurers are subverting the law in subtle ways and the government is not aggressively enforcing it...

(read the full article here)

Media Archives

Obama Administration Issues Final Rule Setting Mental Health Parity Requirements - Bloomberg BNA (11/12/2013)

Resources

ParityTrack - Parity Track seeks to help consumers understand their rights under the Federal Parity Law and state parity laws and to help consumers feel empowered to exercise those rights.

Parity Implementation Coalition - NAMI National is a partner in this coalition work.

Parity Resource Guide - Parity Resource Guide for Addiction and Mental Health Consumers, Providers, and Advocates

Community Catalyst's Guidance For Advocates- This document can help you determine whether or not to file a complaint (shorter version of above).

Enforcing Mental Health Parity - Health Affairs Issue Brief released November 9th, 2015

ARC Insurance Project - While they focus on Autism, these folks can help you navigate your insurance benefits and find out what should be covered.

Aetna Overview of Mental Health Final Parity Regulations - If you are interested in "getting into the weeds," this is a good start!

2014 Report to Congress - Compliance with the Mental Health Parity and Addiction Equity Act of 2008 - DOL report on MHPAEA Compliance

A Political History of Federal Mental Health and Addiction Insurance Parity - Good overview of history and challenges of passing and implementing parity laws.

NAMI Indiana Parity Implementation Subcommittee Materials

Insurance 101 PowerPoint Slides - NAMI Indiana staff, board, and public policy committee members participated in an Insurance 101 training on March 9, 2016.