Insurers must treat mental health like physical health

WASHINGTON (USA TODAY) — Five years after the passage of a groundbreaking law establishing equality between mental health care and other medical treatments, the Obama administration will announce its final rule Friday defining how that treatment must be provided.

According to a report late Thursday in The New York Times, White House officials said the rule would require insurers to charge similar co-payments for mental health treatment as they would for physical ailments, to not require insurer's approval before prescribing a type of treatment and to clarify how parity will apply to inpatient and outpatient treatment for a variety of conditions.

"The rule will really dictate how parity gets implemented," said former representative Patrick Kennedy, who worked with his father, late senator Edward Kennedy of Massachusetts, on the Mental Health Parity Act. "We need to, most importantly, have the attitudes in the right places that this is something that's really going to revolutionize care."

About 26% of Americans 18 and older have a diagnosable mental disorder every year, according to the National Institute of Mental Health.

In 2008, Congress passed and President George W. Bush signed into law the Mental Health Parity and Addiction Act, which demands that mental illnesses be treated the same as other illnesses. Those who have cancer are not denied care after 10 visits if they are not healthy; those with depression should also not be denied care if they are not healthy.

Health and Human Services Secretary Kathleen Sebelius will announce the rule at a mental health conference at the Carter Center in Atlanta. Former first lady Rosalynn Carter has long been a proponent of mental health parity and was heavily involved in lobbying for the law.

Insurers, including the insurance industry trade group America's Health Insurance Plans, have argued that it's too difficult to compare physical illnesses to psychological illnesses in an apples-to-apples way, and they have insisted upon evidence-based guidelines. Mental health experts say they can do that.

The industry also has said the rules could cause premiums to go up. USA TODAY reported Wednesday that there may be an influx of young people diagnosed with mental health issues as they finally gain access to treatment.

However, Kennedy and other mental health experts said, catching those illnesses early may lead to lower costs in the long-term.

Kennedy, who suffers from mental illness, said he expects that the law will help employers save money, because workers will be more productive, and that young people dealing with depression or substance-abuse disorders may get the help they need to allow them to make them productive early-life career decisions.

Also, Kennedy said, improved mental health care will allow mentally ill people with other chronic issues to take better care of themselves.

"I don't think my liberal mind and bleeding heart will be the reason that this gets implemented," Kennedy told USA TODAY. "I believe it will be economics."

But he said everyone in the health system will need to change behaviors to make parity work. Primary-care physicians must ask questions to gain knowledge about a person's mental health, and then they must understand how to get that person further help. Mental health providers may need to start taking insurance to ensure people have access to care. And insurers will need to be transparent about mental health coverage.

"Doctors check cholesterol and blood pressure, but the notion that in this day and age, they ignore a check-up from the neck up that could make all the difference in all the rest of our health is hard to believe," Kennedy said. "We're still stuck in a time warp."


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