New federal rules to make mental health care more accessible, affordable
Michigan Public Health experts can discuss
The federal government has enacted a set of final federal rules aimed at ensuring that people with mental health conditions receive similar insurance coverage for needed care as they would for physical health conditions.
University of Michigan School of Public Health experts can discuss the changes and how they may affect individuals, families, insurers and the health care system, which has made finding and paying for mental health treatment more taxing than other health care needs—and for many people unattainable.
A national shortage of mental health care providers and a rise in diagnosis of mental health conditions exacerbates the issue.
Briana Mezuk is a professor of Epidemiology and co-director for the Center for Social Epidemiology and Population Health at the School of Public Health. Her training and research explore the various ways that mental and physical health intersect throughout life.
She says the new federal rules build on much-needed implementation of core provisions in the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. It is intended to prevent health insurers from limiting or denying patients seeking mental health care.
"Leaders in the field have argued that there is no health without mental health, and the Wellstone Act seeks to ensure that mental health care is given equal footing to medical care. This is an important milestone in addressing the substantial mental health needs of Americans. However, it is critical to understand that even with these regulations, the mental health care needs of Americans will not be met by specialists alone—there are simply not enough psychologists, psychiatrists and social workers, particularly in rural and underserved areas, to meet this need.
"Instead, the vast majority of mental health care in the U.S. will continue to be provided by general practitioners. To support these general practitioners, who often lack training in psychosocial interventions, it is essential that health care systems and payers embrace coordinated team-based care models. Team-based care—which typically involves a general practitioner, nurse and a mental health specialist working together to support the patient—not only generates better clinical outcomes for patients with co-occurring mental and physical health problems, it is also cost-effective for managing such complex health needs. Payers and health care systems need to invest in these types of structural and personnel solutions to complex patient care to genuinely embody the spirit of the Wellstone Act."
Kyle Grazier is the Richard Carl Jelinek Professor of Health Services Management and Policy at
the School of Public Health and a professor of Psychiatry at the Medical School. She
is interested in improving access to behavioral health care services for vulnerable
populations.
Grazier sees progress and reason for optimism in the new federal rules and also knows the improvements meant to repair the current system of mental health care and insurance will take time.
“The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) was groundbreaking in recognizing that mental health and medical/physical health deserve parity in their importance to overall wellbeing, and therefore should be recognized as such in health benefits and insurance coverage. Results of several important studies of the processes for delivering behavioral health services, prevention of the conditions, and outcomes of services demonstrate the imperative for more robust parity enforcement.
"These final rules specifically address how to amend the existing standards for non-quantitative treatment limits (NQTL) to no longer impose greater restrictions on access to mental health and substance use disorder benefits as compared to medical/surgical benefits. The final rules mandate that plans collect and evaluate specific data, use reasonable methods, and apply rule-mandated content in the comparative analysis to assess the impact on outcomes, and report the findings. The new regulations intend to stem the growing trend by group health plans and health insurance issuers to move behavioral health providers out of network, restricting services and financial access, thus making use of these providers more costly to consumers. The Final rule should improve treatment, access, and parity.
“While there is a general shortage of behavioral health providers, the challenges of finding care are exacerbated by the lack of affordable and available access. Even among those who have private health insurance and despite the state and federal parity laws in the past 15 years, group health plans and health insurers that provide mental health and substance use disorder benefits continue to impose less favorable limitations on those benefits than on medical or surgical benefits.
"For the consumer, the out-of-pocket cost for therapy or medication management can be prohibitive, and much more expensive than equivalently complex or time-consuming medical procedures, even if a provider is in an insurer’s network. The stark imbalance between needing care and receiving care has led to a call to respond to the behavioral health crisis.”
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