Widened State Mental Health Benefits

A new Massachusetts law that went into effect July 1 expanded required coverage of medical care for four common mental health disorders.

Massachusetts law prior to July 1

A two-tiered system allowed health insurers to limit treatment for dozens of mental health diagnoses to 24 outpatient sessions and 60 days of hospitalization per year. But it prohibited such limits on nine specific disorders: schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, obsessive-compulsive disorder, panic disorder, affective disorders, delirium and dementia, and paranoia and other psychotic disorders.

Massachusetts law after July 1

Four additional psychiatric conditions are added to the nine without limitations on treatment: autism, eating disorders, substance abuse problems, and post-traumatic-stress disorders. The law also gives the state mental health commissioner the authority to include any additional disorder to this list.

That means, for example, that a drug addict who previously would have been denied treatment after 24 outpatient sessions and a total of 60 days in a hospital will now get as much care as medically needed to tame an addiction.

All Are Not Covered

Not even the new law will ensure that every person in the state who needs those services will get them. Roughly half of Massachusetts companies are exempt from state insurance laws, meaning that they are governed by federal regulations that call for less-generous mental health services.

A new federal mental health law aimed at closing many of the gaps between state and national rules does not kick in for most of these companies until January, and, even then, the rules exempt some of them.

Unfinished Business - Other Levels of Care

There remains one piece of unfinished business. When the state last attempted to overhaul mental health services nine years ago, regulators left untouched the broad range of treatment that falls somewhere between overnight hospital stays and trips to the psychiatrist. That includes such services as residential treatment programs, home-based care, and day treatment programs. In that void, advocates say, patients have often had to battle, frequently failing, to get needed help.

“People with mental illness often have more difficulty navigating the speed bumps that health plans put in place,’’ said Dr. Gregory Harris, a Brookline psychiatrist and chairman of the managed-care committee of the Massachusetts Psychiatric Society.

State Insurance Commissioner Nonnie S. Burnes, who has been meeting for months with leaders from all sides of the issue, said she hopes to issue clear guidelines by the end of summer. “We are working hard with the Department of Mental Health, as well as insurers and providers,’’ she said, “. . . so the consumers of Massachusetts will get what they are entitled to.’’

The Debate

While patient advocates hailed the expansion of mental health assistance, the people who will pay the bills - insurers and companies that provide health coverage to their workers - greeted the law with uncertainty, especially about its cost.

The expansion illustrates two of the most pressing issues in healthcare today: equality for mental health services and the price tag for expanding medical care. “Any step we take that breaks down this artificial divide that exists between mental illness and physical health is a big step,’’ said Matt Noyes, a mental health advocate at Health Care for All, a Massachusetts consumer group.

Supporters of the change, citing the experience of other states, said they expect parity will add less than 1 percent to overall healthcare costs, while easing the stigma of mental illness. Insurers’ overall spending in Massachusetts, estimated at about $13 billion a year, will increase by $13 million to $39 million a year because of the new law, according to regulators’ calculations.

But a coalition of employer and insurance groups contends that the costs are likely to be significantly higher. Insurers said that the state’s calculations substantially underestimate the costs. They have not, however, come up with their own estimates.

“We will be able to tell in about two years from actual experience,’’ said Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, a trade group. “Everything else is an estimate based on what we think will happen. Reality is sometimes different.’’

Last summer, the Chamber of Commerce joined a coalition of business groups that lobbied lawmakers against passage of a more sweeping mental health parity law, which would have required equal coverage for an even broader range of conditions.

-Adapted from: “More care for 4 common disorders”, July 6, 2009, Massachusetts Division of Insurance, http://www.boston.com/news/local/massachusetts/articles/2009/07/06/more_care_for_4_common_mental_disorders/ retrieved 7/6/09, and “Widened mental benefits pose test; Advocates hail law covering 4 disorders; Insurers, employers say costs to be high” By Kay Lazar, the Boston Globe, July 6, 2009.

 

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