For decades, descriptions of the status of U.S. mental health services have included references to service cuts, funding constraints and poor access to care. That makes it only more astonishing and important that the past two months have witnessed the most expansive support for mental-health services in U.S. history. Three critical pieces of federal legislation are responsible for this remarkable turn of events.
Bipartisan support for mental-health services has probably never been this strong before at the U.S. federal level
In early November, the Obama Administration released the final regulations for implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPEA) of 2008. One of the very last laws passed during the George W. Bush Administration, MHPEA affects the more than 100 million Americans who receive their health insurance through large group employers. It mandates that any insurance plan that offers benefits for the treatment of mental-health disorders must make those benefits comparable to those for other medical disorders. In other words, the higher co-pays, more intensive utilization review requirements and lower benefit caps historically applied to mental health care are now illegal.
Just seven weeks after the final MHPEA regulations were issued, Medicare ended its decades-long practice of reimbursing outpatient mental-health care at a lower rate than care for all other disorders. Historically, Medicare had covered 80 percent of all outpatient care except for mental health care, which was reimbursed at only 50 percent. Due to the final implementation of the Medicare Improvements for Patients and Providers Act of 2008 (.pdf), this disparity was eliminated on January 1, 2014. That’s good news for the approximately 50 million Americans who are covered by Medicare.
Last but not least, as everyone knows the remaining provisions of the Affordable Care Act also came into force over the past month. The ACA had already helped families facing mental illness by allowing parents to keep their children on their insurance policies until the age of 26. That was critical because addictive and psychiatric disorders almost always have onset in adolescence or young adulthood. But an even more influential feature of the law is to define substance use disorder and mental-illness treatment as essential health care benefits, and, to specify that those benefits be at parity with benefits for other disorders, such as is specified in MHPEA. This standard will apply to all plans issued through state and federal health insurance exchanges and the Medicaid expansion, as well as to insurance plans to be issued in the future that are subject to ACA regulations. The HHS Office of the Assistant Secretary for Planning and Evaluation projects the impact of these changes as improving mental-health care coverage for more than 60 million Americans.
Of course, while the above changes all were implemented in the past two months, they each were the product of many years of advocacy by office holders, political activists, grassroots organizations, clinicians and researchers. These laws coming to fruition in such a compressed time window was fortuitous in some respects, but it also reflects a new political reality in Washington: Bipartisan support for mental-health services has probably never been this strong before at the U.S. federal level. That augurs well for American families who will face the challenge of mental illness in the coming years.
Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington. He can be followed on Twitter at @KeithNHumphreys.
Previously: Managing primary care patients’ risky drinking, Full-length video available for Stanford’s Health Policy Forum on serious mental illness and How states will benefit from Medicaid expansion