Congress Strengthens Mental Health Parity

Carol Rickard

Carol Rickard, Community Education and Outreach
Depression and Bipolar Support Alliance

With the stroke of his pen on December 13, 2016, as he signed the 21st Century Cures Act, President Obama moved our nation one step closer to treating the whole person and ensuring equal access to health care for individuals living with a mental health condition. This law addresses a wide range of health issues, including a major emphasis on mental health issues. In signing the legislation, the President put into motion critical provisions to improve implementation and enforcement of the 2008 parity law.

The Mental Health Parity and Addiction Equity Act of 2008 (the Federal Parity Law) created much-needed protections for ensuring mental health is treated equally to physical health and ending the discriminatory practices used.  As was highlighted in the August 23, 2016 CFYM post, there has been a great void in implementation and enforcement because the federal law left much of the enforcement to the states. This, in turn, left significant gaps in protection to equal access for individuals in need of mental health treatment. The unintentional consequence: a law enacted to protect people has failed to do so.

In the past year, as the DBSA Community Education and Outreach consultant, I traveled around New Jersey and Pennsylvania conducting parity education events. I met individuals whose lives were greatly impacted by these gaps of implementation and enforcement. I can quickly recall the stories of two women in particular. They were both mothers whose children had a dire need for a higher level of structured treatment. In both cases, the higher level of treatment coverage was denied by their respective insurance plans and they were forced to cover the cost of the treatment on their own. They spoke of how lucky they were to have the financial resources to do so—although they were forced to withdraw from their retirement accounts. However, they were very concerned for all of the other families who may not be in a position to do that. Both of these mothers continue to be active in their ongoing fight over this matter as well as in their advocacy efforts to make sure other parents don’t have a similar experience.

Legislation recognizes the need for accountability
The 21st Century Cures Act offers the missing link that prevented the Federal Parity Law from serving those it was intended to support: accountability. In their bi-partisan effort to strengthen and uphold the promise of the Federal Parity Law, the U.S. House and Senate created several provisions that require federal agencies to lead the way in implementation and enforcement. These include:

  • issuing a compliance document that includes examples of non-compliance and compliance with the law and a requirement to update the document every two years
  • issuing additional guidance on the appropriate design and application of non-quantitative limitations
  • auditing a health plan or issuer when it is known they have five or more investigated violations from complaints
  • convening a meeting of stakeholders (including advocacy groups) and working to create an action plan for how both the federal and state governments can enforce the law—that action plan must be issued within the next 12 months.

Another way the Act creates accountability is through transparency. It

  • requires federal agencies to submit a public report about the nature of their investigations of health plans or issuers
  • mandates that the Governmental Accountability Office (GAO) complete a study on how plans and issuers are complying with the law
  • requires federal agencies inform on how they are doing on enforcing the law, as well as make recommendations for improvement.

Our voices are still needed
History shows us that although these critical provisions have been enacted, the real work is to ensure they are followed. Now is not the time to rest our advocacy efforts around parity. We must continue to raise and direct our voices!

There are several ways we can do this. First, thank your legislators for their work on strengthening mental health parity through the 21st Century Cures Act and encourage them to hold the federal agencies to task. Second, continue to reach out on the state level to ensure the agencies responsible for implementation and enforcement in our own states are actively doing so. Last, speak up when we or someone we know has experienced a situation that may involve a parity issue.

For those of us living in the states where model parity legislation efforts are underway (Connecticut, Illinois, Montana, New Jersey, Ohio, Pennsylvania, and Tennessee), we must continue using our voices to be active in our coalitions, our organizations, and our communities. Most importantly, we must use our voices to help our state legislators get to know us, help them understand the need for true parity, and create support for the legislation.

If you’re not quite sure how to follow up with your state representatives, attend a workshop where you can learn! Many organizations hold workshops where they will teach you how to reach out to your state representatives. In fact, DBSA is holding such a workshop in New Jersey on January 14th to help advocates learn how to use the strength of their voices in support of the NJ model legislation. Follow this link to register for the New Jersey workshop.

Our voices, when combined together, become a force that can be used for great good!

Author’s note: I would like to thank Tim Clement of Parity Track for his assistance in helping me to identify and understand how the 21st Century Cures Act positively impacts mental health parity.

Your Turn

  • How will you advocate for mental health parity in 2017?

Bio
Carol L Rickard, LCSW, TTS, of Hopewell, NJ is founder & CEO of Well YOUniversity, LLC, a global health education company dedicated to empowering individuals with the tools and supports to achieve lifelong wellness & recovery. Also known as America’s Wellness Ambassador, Carol is a dynamic & engaging speaker who brings to life practical / useful solutions. She is a weekly contributor for Esperanza Magazine; written 13 books on stress and wellness, had a guest appearance on Dr. Oz this past winter. She is also the creator and host of a 30-minute wellness show on Princeton TV – The WELL YOU Show. She works for DBSA providing workshops on How To Maximize Your Insurance Benefits by Understanding Parity and is a member of DBSA NJ Board of Trustees, Hunterdon Mental Health Board, and coordinates partnerships for DBSA NJ GO.

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2 comments
fishera
fishera

Although Carol has done some great work in the states she has visited re: mental health parity, what continues to be missing from this discussion is that there is no mental health parity for Medicare pts., such as myself.  Further, I was denied my supplement to Medicare by Mutual of Omaha, based on mental health tx.  When I contacted CMS, to file a complaint, I was told this could happened, since I didn't have to go thru open enrollment, which I did when I turned 65 yrs. young, 10 yrs. ago.  The only way to try and resolve this matter is to expand/extend the open enrollment period for everyone, including us Medicare pts/seniors who have already signed up.  Even if I could have filed a complaint with Medicare, I suspect the only thing that would have happened to any insurance company would have been a "slap on the wrist".  I am a realist as it relates to mental health - the system has been broken for yrs. and its going to take yrs. to fix it.  As a professionally licensed therapist, I know what to do and I can only say that now its becoming much more difficult to find well trained mental health providers, so matter their degree, who will accept Medicare.


I continue to lobby and make my voice heard.  however, its not getting any easier and the small steps that have been taken are only small steps.  "Medicare is killing mental health and its pts" such as myself. and you can be sure I have reached out to those professionals I know who have a lot of training for referrals, and the majority of these folks tell me how many mental health providers are opting out of Medicare.  Why?  Suspect its related to the coding system; low reimbursement rate; and paperwork.  For myself, I know too much as a mental health therapist to be seen on an outpt. basis by someone just starting out and/or going to a clinic wherein I have to see a resident and then the psych doc.  As for outpt. behavioral clinics, in my neck of the woods, i.e., N. Va, Inova Behavioral Health is awful.  Been there, done that.


Unfortunately, I believe that mental health is still at the bottom of the health care system as it relates to tx.  And if i can be denied my medigap plan based on mental health tx., my question continues to be if its not a pre-existing condition and/or a physical condition, where does a mental health dx fit into the scheme of health care?

Annabelle Fisher, MSW; LICSW/PT



Pat Zeiser
Pat Zeiser

I am deeply impressed by Carol and her work.