Legislation would strengthen mental health parity

Congress is considering two bills that would prevent managed-care companies from arbitrarily limiting mental health-care services.

Senators Pete Domenici (R-N.M.) and Paul Wellstone (D-Minn.) have introduced a bill that would prohibit health plans from limiting the number of hospital stays and outpatient visits patients could use for mental health care. The bill is in response to a report issued last year by the National Institute of Mental Health. The report helped demonstrate that despite the removal of annual and lifetime dollar limits for mental health benefits, some managed-care companies were imposing other restrictive measures, such as higher deductibles and co-payments.

Meanwhile, Representatives Marge Roukema (R-N.J.), Robert Wise (D-W.Va.) and Peter DeFazio (D-Ore.) introduced legislation that would prevent insurance companies from setting discriminatory and arbitrary limits on mental health benefits. Their bill would prevent managed-care companies from setting higher deductibles, out-of-pocket payments and extra charges for visits to out-of-network providers. Both bills would strengthen the 1996 Mental Health Parity Act, which requires insurance companies to impose the same annual and lifetime benefit dollar limits for physical and mental services.

Under current law, health plans can discriminate between mental and physical health benefits by limiting hospital days and outpatient visits and imposing higher deductibles or co-payments on mental health benefits. The Domenici-Wellstone bill would lower the existing employer exemption for providing parity. Currently, businesses with 50 or fewer employees are exempt from the law. This new bill would decrease the size exemption to 25 or fewer employees, thereby extending coverage, according to U.S. Labor Department estimates, to 14.4 million people nationwide.

The bill extends full health-insurance coverage only to designated severe biologically based or mental disorders such as schizophrenia, bipolar disorder, major depression, obsessive-compulsive disorders, post-traumatic stress disorder and autism.

Although APA supports the House and Senate bills overall, it would like the Senate proposal to provide nondiscriminatory coverage for all persons who suffer from mental health disorders, regardless of whether their disorder is considered a biologically based illness.

"Many Americans suffer from debilitating and severe mental health disorders that are not on this list--and they and their families don't care whether their illnesses are considered biologically based, or not," says Russ Newman, PhD, JD, APA's executive director for practice. "They want and deserve equal coverage."

--L. Rabasca

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