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Volume 12 Number 242
ISSN 1091-4021
Tuesday, December 18, 2007

News: Mental Health

Proposed legislation on mental health parity could reduce access to mental health care if it does not support the treatment of patients by providers outside of plan networks, according to a study set for Dec. 18 release by the journal Health Affairs.

"Parity proposals that do not require any coverage for out-of-network mental health benefits may paradoxically have the unintended adverse consequence of decreasing access to mental health treatment," said the study, "Parity And The Use of Out-Of-Network Mental Health Benefits In The FEHB Program." They cited in particular their concerns with a Senate-passed proposal on mental health parity (S. 558).

The study authors said access to out-of network care for mental health is important, and cited the experience of the federal government workers' own benefit plan. An analysis of mental health services covered under the Federal Employees Health Benefits (FEHB) program and offered in the Washington metropolitan area found that only about one-third of psychiatrists, psychologists, and social workers in 2005 participated in the FEHB or in other programs such as Medicare, Medicaid, or private health insurance plan networks.

Further, only 44 percent of FEHB patients received mental health care from in-network clinicians in 2005, the study said.

In-Network Provisions

"Our study shows that even in an area relatively rich in mental health resources such as Washington, D.C., and its surroundings, plan networks are not equipped to meet the full need for mental health treatment," lead author Darrel Regier said in a statement. "Maintaining the out-of-network option is essential to ensuring access to treatment."

Regier is the executive director of the American Psychiatric Institute for Research and Education, which conducted the study along with the American Psychological Association, and the National Association of Social Workers.

The study authors wrote that the FEHB program, with 7.9 million enrollees, began providing mental health and substance abuse benefits with parity to general medical benefits in January 2001. They add, however, that the covered mental health benefits were limited to services provided by in-network clinicians who participated in one of the nation's 350 FEHB plans. A total of 790,000 people in the Washington metropolitan area are covered under the FEHB program.

Concern About Senate Bill

While applauding congressional efforts to pass legislation to update mental health laws, the study said that the proposed Mental Health Parity Act of 2007 (S. 558), which was passed in the Senate Sept. 18 by unanimous consent, allows health plans to exclude out-of-network mental health coverage "if they decide that offering such benefits at parity is not in the plans' best interest."

"If the Senate bill prevails, any payment for services could require access restricted to network clinicians only," the authors said.

Sen. Pete Domenici (R-N.M.) introduced S. 558 in February to require that financial cost-sharing, benefit limits, and other financial arrangement for mental health services under group health plans not be more restrictive than the financial requirements set for medical and surgical benefits. After passage in the Senate, S. 558 was referred to the House Education and Labor Subcommittee on Employment, Labor, and Pensions on Oct. 17.

The House version, the Paul Wellstone Mental Health and Addiction Equity Act of 2007 (H.R. 1424), would require employers with more than 50 workers to offer mental health coverage at parity with other health benefits. In addition, the study said the House bill would cover out-of-network mental treatment at the same levels as other out-of-network treatment.

Rep. Patrick Kennedy (D-R.I.) introduced H.R. 1424 in March. The House Energy and Commerce Committee voted 32-13 to approve the legislation on Oct. 16.

Cost Concerns

In a report issued Nov. 21, the Congressional Budget Office said H.R. 1424 would cost the federal government $1.1 billion from 2008 to 2012, and $3.1 billion over the 10 years through 2017 (No. 227 HCDR 11/27/07 a0b5k8b7t4 ).

Some members of Congress have expressed concerns about how to fund H.R. 1424, but Regier said that the introduction of managed behavioral health care has reduced projected costs of offering mental health parity. He added that the CBO report on H.R. 1424 said the legislation would raise group health premiums by only 0.4 percent.

Regier added that if parity for out-of-network benefits is required, one actuarial study has estimated that "20 percent of professional services nationally would be provided out-of-network, with an aggregate increase of 0.6 percent cost increase if unmanaged and virtually no increase if managed."

Other Access Barriers

The authors cited low-reimbursement rates as a reason why some mental health providers were reluctant to take more patients--33 percent of social workers, 51 percent of psychiatrists, and 64 percent of psychologists in the study said the reason they were not currently accepting new patients was because plan fees were too low.

"Expanding network capacity in the national capital area and elsewhere would require major efforts to increase reimbursement and reduce the administrative burden associated with network participation," Regier said in a statement. "These changes do not happen overnight, so it is crucial to maintain an out-of-network option for those in need of mental health treatment."

The mental health professionals surveyed said they spent more time on administrative duties, such as getting authorization for services, for FEHB patients than for out-of-network patients.

The study is expected to be available.