Mental Health Parity Law: Mandated Offering Laws

According to the World Health Organization, mental illness will affect approximately 25% of people at some point in their life (“WHO Qualityrights”, n.d.). Despite that, the current mental health care system in the United States is inadequate. Many aspects of the system need improving, especially the barriers to service. In fact, approximately 20% of individuals are left without necessary treatment for their mental health disorder (“Mental Health”, 2016). Mentally ill individuals have difficulty accessing necessary mental health care services for various reasons; insurance, socioeconomic status, and mental health stigma can all function as barriers to treatment. Insurance discrimination can make it difficult for individuals to find treatment (Han, Call, Pintor, Alarcon-Espinoza, & Simon, 2015). Gaps in insurance coverage can also be a barrier, as they disrupt the long-term treatment process (Gulley, Rasch, & Chan 2011). Socioeconomic status has been found to negatively affect appointment scheduling (Kugelmass, 2016). Finally, stigma in our society can also stop people from seeking out treatment that they need (Bathje & Pryor, 2011). The mental health system in the United States is not capable of caring for the mentally ill, as insurance, socioeconomic status, and perceived stigma all act as barriers that prevent people from receiving the treatment they need.

An interesting finding by Huskamp and Iglehart (2016) is that between the Mental Health Parity Act (MHPA) and the Affordable Care Act (ACA), there should be a rise in people with mental illness seeking services, however, services are underutilized more than ever (Huskamp & Iglehart, 2016). According to Bendant (2014), in 2013 a total of 47 million people uninsured and 25% of those suffer mental illness (Bendant, 2014). These numbers are staggering for a service that is more inclusive now more than ever. The Center for Medicare & Medicaid Services (CMS) site indicates that the MHPA is regulated differently depending on the state (CMS, n. d.). The Department of Labor (DOL) has identified a few problems with the MHPA and addressed these issues to Congress via a 2017 report (DOL, n.

Medicaid coverage and financing augmented access to a variety of behavioral health services, including psychiatric care, counseling, prescription medications, inpatient treatment, case management and supportive housing. Medicaid expansion states have seen higher rates of healthcare utilization in terms of medication and services for the treatment of behavioral and mental health conditions, highlighted by studies that have shown that Medicaid expansion is associated with increases in Medicaid-covered prescriptions for and Medicaid spending on medications to treat opioid use disorder and opioid overdose (1). States that have expanded Medicaid through Section 1115 Waivers experienced coverage gains similar to the states that implemented traditional Medicaid expansions (1). In fact, Indiana made large gains in Medicaid enrollment and the uninsured rate reductions between 2013 and 2015 were higher than the average decrease among the expansion states (1).

Escalating during the great recession and the drug epidemic, the rate of the uninsured and citizens with incomplete MH/SUD coverage escalated to cataclysmic proportions. Relatively, the economics of our nation were impacted by millions of American families affected by MH/SUD disorders that reduced their productivity and earnings potential. However, the fear that MH/SUD parity would further impact struggling businesses and increase the total costs of health care played a crucial role in delaying the passage of individual attempts at parity legislation. Naturally, amendments to a true mental health parity act were inspired by Republican opposition who were against government involvement in regulating health insurance.

Seeking to improve care and lower costs, Florida became the first state to offer a Medicaid health plan designed exclusively for people with serious mental illnesses, such as schizophrenia, major depression, or bipolar conditions. The plan offered by Connecticut-based Magellan Complete Care - is part of a state experimentation to co-ordinate physical and mental healthcare for those enrolled in Medicaid. Mental illness is a big driver of Medicaid costs because it is twice as prevalent among beneficiaries of the public insurance program for the poor as it is among the general population. Studies show that enrollees with mental illness, who also have chronic physical conditions, account

This essay will research and reflect a service user’s perspective on what legal and ethical implications John and his family may go through during his admission onto section 2 and how it will affect different aspects of his life such as; employment, relationships, continuing treatments and engagement issues.

Laws carry overwhelming allegorical value and possess the potential to enhance public opinion; however, the clear imbalance of mental illness treatment further complicates public policy enhancement.

“One of my biggest struggles with dealing with my ‘problems’ was being able to pay for help. At some points I thought the process to receive help was more draining than my illness itself” (May). Mental illness has plagued millions of people in the United States alone, and with the stigma it carried, getting the help that is needed is not always possible. With Proposition 63 in California it is speculated that with proper aid from the government and community those with mental health problems will be better suited to face their demons. That by having a budget to help those desperately in need we can better the lives of those who struggle with mental illness.

What is left is that we have many citizens who are mentally ill and are not receiving treatment. However the patients who are able to receive treatment are only able to have some treatment covered. Health insurers are responsible for covering the immensely large cost of substantial treatment, a mixture of medication and therapy; since therapy is highly priced, less reliable, and time consuming; patients typically do not receive treatment for therapy. Health insurers would much rather cover medication because it is cheaper, it heals patients faster, and it is more reliable than therapy. However, medication is not made to heal, but to only coax symptoms of a mental illness (Sandberg).

Under the Employee Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act (MHPAEA), plan participants and providers are entitled to receive access to certain plan information, reasons for denial of coverage or benefits, and copies of the medical necessity criteria used to make benefit determinations. In order to facilitate these document requests, NYSPA prepared form letters that can be used by psychiatrists and patients. Through document requests and sharing of materials, they hope to identify ongoing patterns and practices of discrimination, the next step in ensuring full enforcement of the parity laws.

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is an act that requires parity or equality between mental health treatment and medical/surgical treatment covered by private and public insurers with over 50 employees. That means that if an insurance covers mental health issues they can’t impose more stringent limits and financial requirements than medical/surgical coverage. The act was signed into law in 2008 by President George W. Bush. Before the act was signed into law, mental health care was not as affordable or accessible for individuals. (United States Department of Labor, 2016)

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted on October 3, 2008 as sections 511 and 512 of the Tax Extenders and Alternative Minimum Tax Relief Act of 2008. MHPAEA amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act (PHS Act), and the Internal Revenue Code of 1986 (Federal Register, 2013). The MHPAEA is an extension of the Mental Health Parity Act of 1996, which prohibited annual or aggregate lifetime financial limits on mental health coverage by addressing other restrictions, such as limits on outpatient visits or inpatient days (DOL, 2010). MHPAEA expands parity requirements to treatment limitations, financial requirements, and in- and out-of-network covered benefits (Smaldone, 2010). It also expands the opportunity of mental health parity requirements at the federal level and includes substance use disorders within its scope. Prior to 1996, health insurance coverage for mental illness had historically been less generous than that of other physical illness (Sarata, 2011). Mental health parity is a response to this disparity in insurance coverage, and generally refers to the concept that health insurance coverage for mental health services should be offered equally with covered medical and surgical benefits (Smaldone, 2010).

There are great health care benefit programs for employees in most organizations. However, the age limitations are causing serious concerns when it comes to mental care for dependent adults over the age of 26. This needs to change, as mentally ill patients over the age of 26 are left without healthcare insurance; which is never a good thing. Mentally challenged individuals deserve to be protected and covered as dependents under their caregiver’s insurance plans as long as they live. The term dependent should not be restricted to an age, but rather be a term that defines the individual who is unable to provide for themselves due to some mental disorder. Therefore, if organizations change their policies and include the mentally ill as a dependent regardless of age, then, it is likely for economies to see declining crime rates, less cost to taxpayers for essential services, and better overall rehab facilities.

Mental Health has been recognized, as the well-being at which individuals are able to cope with everyday stresses, and work productively while contributing back to their community. Mental Health America began in the early 1900’s by Clifford W. Beers, a former psychiatric patient who experienced mental/physical abuse during his stay in public and private institutions. It wasn’t until short after a reform group emerged, to stand against the abuse and ill-treatment at these institutions. In this paper, I will be discussing the history/background of Mental Health Services, and how quality, access, cost or other factors have changed (or how they haven’t). I also will be discussing the populations that benefit from this type of service and the significant issues, and or problems within the area that impact specific populations. Lastly, I will interpret national policy, legislation, attitudes, political climate, and how they impact or relate to the problems discussed, then I will address two current issues discussed along with clarifying each discussion.

An extremely complicated portion of insurance is in life insurance. Something even more complicated is life insurance and the idea surrounding mental illness. Some of the main issues regarding this topic are that you may be denied life insurance, if determined to be unsuitable for it due to a mental illness, as well as potentially being denied benefits if the policyholder commits suicide before a policy’s exclusion limitation because of such a mental illness. Consequently, mental health patients face a challenge in trying to obtain life insurance.