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White House Boosts Insurance Coverage for Mental Illness

FRIDAY, Nov. 8 (HealthDay News) -- U.S. health officials unveiled long-awaited rules Friday that require insurance companies to cover treatment for mental illnesses and addiction the same way they cover physical illnesses.

Secretary of Health and Human Services Kathleen Sebelius, who announced the regulations at a health conference in Atlanta, said this is "the largest expansion of behavioral health benefits in a generation."

The regulations will make the 2008 Mental Health Parity and Addiction Equity Act a reality, and fulfill a generation-long effort to improve benefits and treatment for people with mental health issues or substance abuse problems.

Co-pays, treatment limits and deductibles can't be more stringent for people with mental illness than for people with a physical illness, under the new rules. This means insurance providers "can't say you can only get substance-abuse treatment in state but you can go anywhere for medical/surgical" treatment, a senior Obama administration official told The New York Times, which broke the story on Friday.

Nor can insurers deny coverage for someone with a history of depression, attention-deficit/hyperactivity disorder, anxiety or other common conditions, mental health experts said.

An estimated one-quarter of Americans have some form of mental illness, according to the U.S. Centers for Disease Control and Prevention.

This "incredibly important law, combined with the Affordable Care Act, will expand and protect behavioral health benefits for more than 62 million Americans," Sebelius said. "People who either have insurance coverage now and have no mental health coverage or where the Affordable Care Act fills in those gaps for people who have no insurance at all, they will be able to access affordable care."

Mental health advocates welcomed Sebelius' announcement.

People with mental illness have long faced discrimination in health care through unjust and often illegal barriers to care, Dr. Jeffrey Lieberman, president of the American Psychiatric Association, said in a statement. This final rule "provides a crucial step forward to ensure that patients receive the benefits they deserve and are entitled to under the law," he said.

Lieberman added he is hopeful there will be strong monitoring and enforcement of the law by states and the federal government.

Dr. Victor Fornari, director of the division of child/adolescent psychiatry at North Shore-LIJ Health System in New Hyde Park, N.Y., said, "We have been fighting for parity for a very long time."

The way Fornari views it, "Every effort to have increased access to health care, including mental health care, is progress in a civilized society."

The rules will affect most Americans with health insurance, including health plans bought under the Affordable Care Act of 2010. However, the regulations may not apply to people covered by Medicaid, the publicly funded insurance program for the poor, or Medicare, which provides coverage for seniors, the Times reported.

Simon Rego, director of psychology training at Montefiore Medical Center/Albert Einstein College of Medicine in New York City, said the effects of the new rules will be wide-reaching.

"Ultimately issuing these regulations is a wise investment that should pay dividends down the road in terms of improved quality of life for the population and cost-savings for the insurers," said Rego.

"We in the mental health field have known for some time that providing patients with mental health and substance abuse disorders the care they need can have tremendous benefits in a number of other key areas," he said. Decreased absenteeism and increased productivity at work, greater satisfaction in relationships and housing situations, and more successful treatment of physical/medical illnesses are just some of these benefits, Rego said.

While Fornari applauded the effort to attain parity, he said he was concerned that improved access to mental health care might strain the system. "We do not have enough mental health practitioners in the country," he said.

"At least this would allow people the equal possibility to seek care, and now the question is going to be finding the appropriate care," he added.

Expanding access to mental health coverage is also part of President Obama's strategy for reducing gun violence in the United States. In the wake of the mass shootings last year in Connecticut and Colorado, the Obama administration sought support to improve mental health benefits as part of the effort to curb killings.

Former Rep. Patrick Kennedy of Rhode Island, son of the late Sen. Ted Kennedy of Massachusetts, co-sponsored the 2008 law. He said the rules will also provide much-needed help to veterans "for the invisible wounds they have brought home from Iraq and Afghanistan," according to the Times.

More information

The U.S. Centers for Disease Control and Prevention has more about mental illness.

SOURCES: Jeffrey Lieberman, M.D., president, American Psychiatric Association, statement, Nov. 8, 2013; Victor Fornari, M.D., director, division of child/adolescent psychiatry, North Shore-LIJ Health System, New Hyde Park, N.Y.; Simon Rego, Psy.D., director of psychology training, Montefiore Medical Center/Albert Einstein College of Medicine, New York City; Nov. 8. 2013, news release, U.S. Department of Health and Human Services; The New York Times