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New rules set standard to ensure mental health care coverage parity

November 8, 2013 at 12:00 AM EDT
The Obama administration made the final step Friday to expand mental health care, five years after a law requiring the coverage passed. The new regulations mandate that insurers cover mental illness and addiction the same as they would a physical ailment. Hari Sreenivasan talks to Dr. Carol Bernstein of New York University.
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JUDY WOODRUFF: Back in 2008, President George W. Bush signed a new law guaranteeing mental health parity that required insurers to treat mental illness similar to other diseases. But it’s taken five years before the latest and final regulations were released today to fully implement the law.

Among other things, it means the law will guarantee fewer limits on doctor visits and hospital stays.

Hari Sreenivasan is in our New York studio with a look at the changes for patients and what happened over those five years.

HARI SREENIVASAN: For that, I’m joined now by Dr. Carol Bernstein, who is an associate professor of psychiatry at New York University’s School of Medicine and the past president of the American Psychiatric Association.

So, this law went on the books in 2008. Help us understand concretely, what are the changes that happened today?

DR. CAROL BERNSTEIN, New York University School of Medicine: Well, this is a very, very important day for all of us, and I think it just has taken a little bit too long to happen, I think.

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When these laws go into effect, if they happen, but in order for them to be enacted properly, a series of regulations have to be promulgated by the government to tell in this case the insurance industry and patients and providers exactly what this law means. So these regulations that are coming out today is the first time that the government is really setting forth exactly how the parity law is supposed to be implemented.

HARI SREENIVASAN: So what are some examples?

CAROL BERNSTEIN: So examples are, this law is the first time on the books that it says that patients suffering from mental illnesses as well as other medical conditions are entitled to the same type of benefits under insurance policies as people suffering from other medical conditions.

Up until now, there’s been a lot of stigma against patients who have mental illness, and they have really been subject to a lot of limitations that patients suffering from other kind of illnesses have not been. For example, often, there is a 30-day lifetime limit on in-patient psychiatric hospitalization for psychiatric illnesses and substance abuse, or a 10-visit or even 30-visit limit per year on how frequently you can see your mental health provider.

Those kinds of limitations were never in effect for other kinds of doctors. You could go see your internist as much as you want. If you got sick and needed to be in the hospital for six months, insurance would cover. But patients suffering from psychiatric illnesses were discriminated against.

HARI SREENIVASAN: So, the insurance industry in one of their statements today said that this has been a top priority for their industry. They have been trying to make it affordable.

Now, in the past, they have made this comparison that, you know what? Physical ailments and mental ailments are — it’s not apples to apples, the cost structure is very different. Is that fair?

CAROL BERNSTEIN: Well, I think we can say that the cost structure has not been the same.

And I think that there has always been a fantasy, somehow, that if you open mental health services to people, that the system will go bankrupt. We already know how much trouble the system is in. And, in fact, if you look statistically at what goes on with the patients who are using the most of our health care dollar, they’re patients who are suffering from both medical illnesses and other medical illnesses, such as psychiatric ones, and if they’re only getting treated for half the bargain, they are going to be sicker for longer and cost the system more.

HARI SREENIVASAN: So, is there a gap in what is covered today and what is not when it comes to private insurers allowing people to take their mental illness and go find a provider?

CAROL BERNSTEIN: Well, to the extent that you have not been able to stay in the hospital as long as you need to, or see your mental health provider as frequently as you could see your physician, yes.

I mean, I don’t know exactly what those dollar amounts are. But most importantly, the problem is that people aren’t getting the care that they need. So, they don’t get the care that they need. They can’t work. They can’t take care of their families, and there’s a much greater drain on the economy.

HARI SREENIVASAN: Also, connect the dots for us. What is covered under the Affordable Care Act and what is covered under this law that has a little bit more specificity today?

CAROL BERNSTEIN: Right.

So, what I would say is that having the parity law come first was critically important, because, without parity, if you had the Affordable Care Act, we would still have this disparity between coverage for psychiatric illnesses and coverages — coverage for other medical conditions.

And I really want to stress the fact that psychiatric illnesses are medical conditions, just like diabetes, cardiovascular disease, hypertension, cancer, AIDS, all of those. But they have been considered as separate. So the parity law now will mandate the structure of the Affordable Care Act to the extent that we — the insurance industry and the government — and this has been true in government programs — will have to provide for equal types of benefits for mental illnesses and substance abuse problems as they do for other illnesses in medicine.

HARI SREENIVASAN: So this is something that people who perhaps didn’t have insurance, if they went through a health care exchange…

CAROL BERNSTEIN: Yes.

HARI SREENIVASAN: … these are now benefits that they are entitled to?

CAROL BERNSTEIN: Yes.

I don’t know the wording of the exchanges and how they develop, but to the extent that the insurance companies that participate in the exchanges have more than 50 — have more than 50 people in the system or insurers, rather, have more than 50 people in the workplace, and to the extent that mental health benefits are offered — they have to be offered. That’s one thing that’s different.

They must be offered at par and in the same way that access to other medical conditions are.

HARI SREENIVASAN: You know, as we approach the one-year anniversary of the Newtown tragedy, there was a tremendous amount of conversation in the country about mental health coverage. It was actually one of the 23 or so recommendations that the administration made.

So, does today basically fulfill that requirement on that checklist that the White House had?

CAROL BERNSTEIN: I don’t know that I would say that it fulfills the requirement. It’s certainly an important step in the right direction.

I think it’s important to remember that most patients suffering from mental illnesses are not going out and shooting people. There are issues, but there is no question that to the extent there has been lack of access, lack of good care, and stigma, that patients suffering from psychiatric disorders have not gotten access to the care that they really need to prevent tragedies like Newtown or others, where there might have been someone who was suffering from mental illness involved.

HARI SREENIVASAN: So, one of the criticisms I have been seeing even of these guidelines today is that there are still vulnerable populations, perhaps in the case of children not covered in the Children’s — the CHIP program.

So, are there still populations that aren’t going to get the services that they need, even with these new rules?

CAROL BERNSTEIN: I’m sure there are.

And I think that there are a lot of challenges — and this is why the regulations are so important — in how the plan is implemented, because even up until now, even though some insurance companies have been very careful and are now applying the same deductible structure to mental illness and substance abuse as they have to other medical conditions, they have been sort of going around, skirting around the issue of parity by doing things that we call are non-quantitative treatment limitations.

What that refers to are requirements to, for example, get clearance from your insurance company before you can call your psychiatrist up. Those are all ways in which populations that need access to care aren’t going to get it if they don’t understand that they’re entitled to do that.

HARI SREENIVASAN: All right, Dr. Carol Bernstein, thanks so much for your time.

CAROL BERNSTEIN: Thank you very much.