Mental health parity.

Abstract

Probably the most far-reaching legislation that affects nurse therapists today is that of mental health parity. Officially designated Decade of the Brain, the 1990s brought unprecedented federal and state legislation to end health insurance discrimination against individuals with mental illnesses. Federal Parity Mental Health Parity Act of 1996. The Mental Health Parity Act of 1996 became effective January 1, 1997, and will sunset on September 30, 2001. It requires employers that offer mental health benefits to set annual and lifetime caps equal to those for medical and surgical benefits. The measure excludes businesses with 50 or fewer employees, and allows all employers to be exempted from the law if their costs rise more than 1% as a result of complying with the requirements. The law allows health insurance plans to set different benefit levels for copayments, deductibles, out-of-pocket payments, inpatient hospital days, and outpatient visits. Relationship to state law. A state law requiring more comprehensive coverage is not weakened by the federal parity law, nor does the federal law preclude a state from enacting stronger parity legislation. On April 14, 1999, U.S. Senators Pete Domenici (R-NM) and Paul Wellstone (D-MN) introduced the Mental Health Equitable Treatment Act of 1999, which would require full health insurance parity for the most severe, biologically based mental illnesses. This legislation would prohibit unequal restrictions on annual and lifetime mental health benefits, inpatient hospital days, outpatient visits, and out-of-pocket expenses. Variations and amendments to this federal bill are being considered. Overview of State Parity Laws After the Mental Health Parity Act of 1996 was signed into law, the momentum shifted to the states. A firestorm of legislative activity created a patchwork quilt of various parity laws around the country. A total of 28 states now have some degree of mental health parity, with fairness bills pending in many other state legislatures. Depending on the state, mental health parity may include any combination of the following two items: 1. Equalization of insurance benefits in relation to annual and lifetime caps 2. Equalization of benefit levels for copayments, deductibles, out-of-pocket payments, inpatient hospital days, and outpatient visits. In 1999, 11 states (California, Hawaii, Indiana [expansion of '97 law], Louisiana, Missouri [expansion of '97 law], Montana, Nebraska, Nevada, New Jersey, Oklahoma, Virginia) and two territories (Guam, Puerto Rico) passed parity legislation. In 1998, four states (Delaware, Georgia, South Dakota, Tennessee) passed parity legislation. In 1997, nine states (Arizona, Arkansas, Colorado, Connecticut, Indiana, Missouri [managed care only], South Carolina, Texas [expansion of earlier requirement], Vermont) passed mental illness parity legislation. Between 1991 and 1996, seven states (Maine, Maryland, Minnesota, New Hampshire, North Carolina [state employees only by administrative order], Rhode Island, Texas [state employees only]) effected mental illness parity measures. As each state passes some form of parity legislation or expands existing law, managed care networks are opening up to accept additional therapists to handle the increased workload. The NAMI website gives a state-by-state breakdown of mental illness parity laws. At this site it is possible to find out the specific provisions each state has passed, if any, and when the law has or will become effective. If you reside in a state that has recently passed or amended parity legislation, you are in a window of opportunity that will not last long. Once networks reach their provider quotas, it will be very difficult to gain entry. To take advantage of this window of opportunity, here are several steps you can take: 1. …