New mental health parity law expands insurance coverage for mental health, substance abuse treatment
Legislation to allow millions to seek treatment for mental health, substance abuse conditions at acute detox programs such as Mills-Peninsula’s
BURLINGAME, Calif. (Nov. 18, 2009) – With nationwide attention riveted on the health care overhaul debate, Congress has quietly enacted a smaller piece of health care legislation with crucial importance for many Americans.
Called the Mental Health Parity and Addiction Equity Act of 2008, the new law will impact millions of people as most new or renewed insurance policies go into effect January 1, 2010. The law requires all group health plans with 51 or more employees, including self-insurance plans, to cover mental health and substance abuse conditions at the same level as medical conditions. For example, if a plan pays 100 percent of a hospital bill for gall bladder surgery or pneumonia, it must cover a patient’s hospital stay for a psychiatric, drug or alcohol stay at 100 percent. Until now, many insurers paid less for psychiatric and substance abuse hospitalizations or set higher co-payments and strict limits on treatment. The new law also extends the same parity standard to outpatient treatment, removing visit limits or caps on coverage.
The number of people who will be helped by this law may be huge. The Substance Abuse and Mental Health Service Administration (SAMHSA), a division of the Department of Health and Human Services, estimates that 11 percent of Americans suffer from serious psychological distress and that 9 percent have a substance abuse disorder.
In California, this national legislation will have more impact for those suffering from substance abuse. Since the mid-1990s, California has had its own Mental Health Parity Act but the state has never implemented a comparable parity requirement for substance abuse treatment.
“The greatest barrier to treating people in need of intensive substance abuse treatment has been their inability to pay for this vital service,” says Dr. William Glatt, Medical Director of the Mills-Peninsula Acute Detoxification Program for the past 28 years. “Now that that barrier has been removed in most insurance plans, our detox program can help more people turn their lives around and get a fresh start.”
This new law is of particular importance now, as tens of millions of American workers are electing their health insurance coverage for 2010 — a period known as open enrollment. Unfortunately, many people do not thoroughly review their plan benefits options, and simply "roll over" their current insurance coverage, assuming it will contain the same benefits as last year. But given the complexity of insurance plans — and loopholes in laws governing coverage — this can be a dangerous assumption.
Case in point: Although the Act requires benefit parity, it does not specifically require health plans to offer either a mental health or substance abuse treatment benefit. Rather, the law requires that if a plan does cover one or both conditions it must provide the same level of coverage as for medical treatment.
“Before you make your health insurance choice for 2010, know what you’re getting,” Dr. Glatt said. “Mental, drug and alcohol heath, including freedom from addiction, is an important component of a person’s overall heath and well being. Read your company’s plan carefully to ensure you have the coverage you expect.”
With the insurance coverage hurtle soon to be removed for many, the behavioral health team at Mills-Peninsula is expecting to see a rise in the number of people seeking treatment for substance abuse issues. The hospital’s Acute Detoxification Program is one of the few hospital-based detoxification centers in San Mateo, San Francisco and Santa Clara counties.
Mills-Peninsula is uniquely qualified to treat people with serious drug and alcohol conditions. Treatment is provided by an experienced multidisciplinary team, and all the Mills-Peninsula addiction medicine physicians are certified by The American Society of Addiction Medicine (ASAM). Mills-Peninsula is a Medicare-approved facility. The department provides a comprehensive treatment continuum including outpatient services for people with less severe conditions.
To schedule an assessment at Mills-Peninsula’s Behavioral Health Services, call 650-696-5909 Monday through Friday during normal business hours. In an emergency, the Mills-Peninsula Psychiatric Emergency Service (PES) is available 24/7. PES is located on the first floor of Peninsula Medical Center next to the Emergency Department, 1501 Trousdale Drive, Burlingame.
For more information about Mills-Peninsula Behavioral Health program, visit our Web site at www.mills-peninsula.org/behavioralhealth.
Mills-Peninsula contact: Ron Kemper, 650-696-5902, KemperR@sutterhealth.org