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Jeanne Ryer and Benjamin F. Miller: N.H. leads most states on mental health parity, but there’s room for improvement



For the Monitor
Friday, November 09, 2018

Access to mental health services is elusive for many, and deaths from drug and alcohol misuse, and suicide have skyrocketed.

In reality, few individuals who have a mental illness or a substance-use disorder get the care they need. Consider that just one in 10 individuals who need substance-use treatment accessed them at a specialty facility in 2016. In New Hampshire, 17 percent of our residents reported having been diagnosed with depression. An estimated 82,000 New Hampshire residents have a problem with alcohol dependence and 37,000 are dependent on illicit drugs. And, currently, the state’s health care system – like the rest of the country – is fragmented, with mental health being seen as a separate and distinct element for decades.

In 2018, no one argues about the need to cover and improve access to mental health services. Yet, mental health parity laws – those which require insurers to cover mental health issues, such as depression or substance use disorders, at the same level as illnesses of the body, such as chronic or infectious diseases – remain incredibly weak for almost every state.

In fact, in a recent analysis, 32 states received a failing grade when it comes to enforcing parity. While the state had the fifth best score, New Hampshire tallied just 71 out of 100 – the state’s laws certainly have room for improvement.

Stronger state statutes enforcing parity laws are one of the critical foundations for helping end discrimination in the coverage of mental health and substance use disorder services, and change the culture of what people can expect from health care.

In New Hampshire, the previous commissioner of the N.H. Insurance Department convened the Behavioral Health and Addiction Services Advisory Committee to address issues such as mental health and substance use disorder parity and conducted a market conduct examination of the state’s largest insurance carriers. Advocates, educators and regulators in New Hampshire have published resources to help consumers answer questions about insurance coverage and parity for mental health and substance use services. But, the federal laws that require most health plans to include insurance coverage for mental health and substance use disorders are being eroded.

Without robust parity laws and their enforcement, it’s basically a lottery as to what type of care a person might get. There is little accountability or transparency around enforcement as to what plans offer for medical and mental health benefits – patients, providers and policymakers often do not know whether a health plan complies with the parity law and what they should be expecting from their health benefits.

While New Hampshire has made some progress on parity, state policymakers can take a number of steps, right now, to improve parity and help ensure people have proper coverage for mental health and substance use disorders.

1) Mental health conditions must be recognized as broadly as “physical” health conditions. This will ensure the full gamut of mental health conditions are covered as comprehensively as physical diagnoses.

2) Co-pays and out-of-pocket costs must be the same for mental health services as they are for physical health services. As such, states should require that benefit management processes and treatment limitations are no more restrictive than similar limitations for physical health benefits. Mental health services must also have the same coverage limits as services for the treatment of physical ailments.

3) Policymakers should strengthen enforcement and compliance activities by empowering regulatory agencies to enforce parity laws, including the Federal Parity Law. In addition, states should require monitoring agencies to regularly report on steps taken to enforce compliance and mandate that all health benefit plans submit regular analyses demonstrating compliance with the law.

4) Policymakers should increase parity enforcement efforts and update oversight mechanisms through intensive compliance verifications and reviews of consumer complaints and by requiring health plans to submit detailed compliance analyses and compelling plans to come into compliance.

5) Policymakers should designate a lead for parity with the commensurate resources to regulate and enforce parity laws and hire and fund consumer advocate offices and other experts who can help patients understand, file, and process parity claims and appeals.

Parity remains elusive for many. Everyday people are being denied care and have few resources to advocate on their own behalf. It’s time to right a wrong – to see mental health for what it is: an essential and core component to health and well-being.

We cannot afford to sit idly by as decades pass – people need comprehensive mental health coverage and care. Now.

(Jeanne Ryer, M.S., Ed.D., is director of the N.H. Citizens Health Initiative and directs projects on health care delivery system and payment reform at the University of New Hampshire’s Institute for Health Policy and Practice. The view and opinions expressed are those of the author and do not imply endorsement by UNH. Benjamin F. Miller, Psy.D., is the chief strategy officer at Well Being Trust. He previously worked at the Department of Family Medicine at the University of Colorado School of Medicine, where he was the founding director of the Eugene S. Farley, Jr. Health Policy Center and currently remains a senior adviser. Follow him on Twitter: @miller7. )