Mental Health Update | Mental + Physical health must b treated equally

When the White House Mental Health and Substance Use Disorder Parity Task Force held its first public meeting this past May, the message from psychiatric professionals was clear:

Parity in insurance coverage for mental health care is still far from a reality.

The task force held its session at the American Psychiatric Association’s 2016 Annual Meeting, before a standing-room only crowd of about 200 psychiatrists and mental health advocates including former first lady Rosalynn Carter and former Congressman Patrick J. Kennedy.

APA President Reneé Binder said there have been “great strides” made in some areas under the Mental Health Parity Equity and Addiction Act, but “there are still significant problems with enforcement.”

“The challenge facing the task force and our profession is ensuring that the parity law is carried out and enforced so that the requirement that mental health and physical health be treated equally becomes an everyday reality,” she said.

Phyllis Borsi, assistant secretary for the Employee Benefits Security Administration in the U.S. Department of Labor, which is responsible for administering healthcare and parity laws, asked the audience for ideas on how to solve the issues that remain.

“As you can tell from the fact that we’re here today, this is a very high priority – implementing this law, making sure that we do it in a way that protects patients,” Borsi said.

Richard Frank, assistant secretary for planning and evaluation at the U.S. Department of Health and Human Services, said parity and healthcare laws now cover about 170 million Americans.

Borsi and Frank heard from about 20 psychiatrists and advocates, many of them selected to speak on issues the APA said are representative of its members’ concerns.

Those included onerous prior authorization requirements that delay urgently needed care or medication; medical necessity determinations being made by people with limited medical backgrounds; regulations that lead to inadequate insurance networks; and a lack of accountability and responsiveness from insurance companies. In many cases, the same practices are not occurring with non-mental health patients, they said.

Insurance companies are “moving in directions that are harder to see and harder to capture,” said Irvin Muszynski, director of the APA’s Office of Healthcare Systems and Financing.

“These insurance companies do not do this for other chronically prescribed medications for medical/surgical issues,” he said. “A diabetic does not need continuous prior authorization for insulin. And patients with high cholesterol do not need constant prior authorizations for cholesterol-lowering medications like Lipitor.

• Robert Feder, MD, spoke about his experiences treating patients for substance use disorders in New Hampshire, one of the states hit hardest by the nation’s opioid addiction crisis. He said the state’s insurance companies require prescriptions for buprenorphine, which treats opioid addiction, every 3 months, despite it being commonly prescribed as a chronic, long-term treatment.

The prior authorization process often leads to a delay in opioid addicts getting their medication, which frequently leads to a relapse of using heroin or other illegal drugs, putting patients at significant risk for overdose and death, Feder said.

• Jerry Halvorsen, MD, medical director at Rogers Memorial Hospital in Oconomowoc, Wisconsin, said he too has difficulty getting approval for opioid-addicted patients. Insurance companies won’t admit them to the hospital if they are not suicidal, and outpatient facilities won’t accept them if they are still in withdrawal, he said.

The APA presented a set of suggestions to the task force, including more audits of insurance companies, public reporting on the audits, and requiring insurance companies to report figures such as medical necessity denial rates, reimbursement rate disparities, and out-of-network claims rates.

Reference: White House Mental Health and Substance Use Disorder Parity Task Force public meeting. Held at the the American Psychiatric Association annual meeting. May 17, 2016.