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Volume 12 Number 215 News: Mental Health Twenty-eight states have laws requiring that health plans covered by their laws must provide full-parity mental health benefits, according to a report from the Congressional Research Service. The report, dated Oct. 19, said that an earlier survey had concluded that state parity laws "have had no discernible impact on the overall use of mental health services" and that "utilization of mental health care was no higher in parity states than in states without such laws." The earlier survey, conducted by a group called Health Care for Communities and covering the period 1996-1998, concluded that the insurance market responded to parity laws by increasing the management of care, in order to control costs. According to the HCC researchers, results of their survey "reinforce concerns about the impact of parity on access to quality health care." A recent study of the implementation of a 1998 parity law adopted in Vermont "also found that the increased use of managed care, while helping make health care more affordable, may have reduced access and utilization for some services and beneficiaries," CRS said in the report, Mental Health Parity: Federal and State Action and Economic Impact. Vermont's parity law, described by CRS as one of the most comprehensive in the United States, covers both mental health and substance abuse treatment services. The study, conducted by Mathematica Policy Research Inc., found that the two health plans that covered the bulk of the state's population made changes in their management of mental health and substance abuse services. For one of the two dominant health plans, managed care "was an important factor in controlling costs following implementation of parity." Before the parity law, most members received mental health services through indemnity contracts. After parity, most received the services through a managed care "carve-out," and "reported a decline both in the likelihood of obtaining mental health treatment and in the average number of outpatient visits," CRS said. The other dominant health plan in Vermont increased the use of partial hospitalization treatment and group therapy and reduced the use of inpatient treatment. The CRS report was designed to provide background information for congressional consideration of federal mental health parity legislation. The House Energy and Commerce Committee on Oct. 16 approved a parity bill (No. 200 HCDR 10/17/07 ). The Senate approved its version of parity legislation in mid-September (No. 182 HCDR 9/20/07 ). The CRS report provides a side-by-side comparison of the House and Senate bills and information about the positions of the various interest groups on the issue. In a section on mental health parity issues for Congress, CRS said that the results of a 2002 survey by the Kaiser Family Foundation and the Health Research and Educational Trust suggested that mental health parity may be difficult to establish without federal parity laws. "State parity laws have a limited impact because they do not cover self-insured plans," CRS said, noting that the federal Employee Retirement Income Security Act exempts self-insured plans from state regulation and about 52 percent of covered workers are in self-insured plans. To order the CRS report for a fee, call BNA PLUS at 800-372-1033, Option 5, then Option 2, or e-mail bnaplus@bna.com.
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