What is Metal Health Parity? A Cosumer Guide to the Evaluatig State Metal Health ad Addictio Parity Statutes Report
Authors: 1 Mega Douglas, JD; 2 Katherie Dowd, MS; 2 Kathlee Tampke; 1 Sharo Rachel, MA, MPH; 2 Eve Byrd, DNP, MPH; 3 Bejami F. Miller, PsyD; 4 David Lloyd, MBA; 1 Gleda Wre, MD, MSHP Author Affiliatios: 1 Morehouse School of Medicie, 2 The Carter Ceter, 3 Well Beig Trust, 4 The Keedy Forum Fudig Sources: This work was fuded with geerous support from The Scattergood Foudatio, The Keedy Forum, The Keedy-Satcher Ceter for Metal Health Equity i the Satcher Health Leadership Istitute at Morehouse School of Medicie, ad The Carter Ceter ad Well Beig Trust. Suggested Citatio: Douglas, M., Dowd, K., Tampke, K., Rachel, S., Byrd, E., Miller, B., Lloyd, D., Wre, G. What is Metal Health Parity? A Cosumer Guide to the Evaluatig State Metal Health ad Addictio Parity Statutes Report. The Keedy Forum; 2018. Correspodig Author: Mega Douglas, JD, mdouglas@msm.edu Published by The Keedy Forum 2018 Keedy Forum www.thekeedyforum.org Electroic copies of this report are available at ParityTrack.org/Aiversary
What is Metal Health Parity? A Cosumer Guide to the Evaluatig State Metal Health ad Addictio Parity Statutes Report Metal Health Parity is YOUR right. What Is Parity? The Metal Health Parity ad Addictio Equity Act of 2008 (MHPAEA), also kow as the Federal Parity Law, requires isurers to cover illesses of the brai, such as depressio or addictio, o more restrictively tha illesses of the body, such as diabetes. Curret law requires health isurers to apply similar processes ad restrictios for treatmet ad coverage of metal health ad substace use disorders as they would for medical ad surgical beefits. Whe a health isurace pla has parity, it meas coditios that share the same characteristics are treated i the same way. For example, the umber of visits you are provided, your copaymets, ad the level of treatmet coverage for depressio would be similar to those for diabetes. 1 Curret law requires health isurers to apply similar processes ad restrictios for treatmet ad coverage of metal health ad substace use disorders as they would for medical ad surgical beefits. What Does Parity Mea for Me? Prior to the passage of the 2008 Federal Parity law, isurace plas typically did ot cover metal health coditios at rates comparable to those for physical health coditios. 2 Most health plas are required by law to follow the Federal Parity Law. This icludes most employer-sposored group health plas ad idividual health isurace coverage. 3 Most group health plas, Medicaid Maaged Care Orgaizatios (MCOs), State Childre s Health Isurace Programs (S-CHIP) ad idividual health plas sold i the Health Isurace Marketplace through the Patiet Protectio ad Affordable Care Act (ACA) (i.e. Obamacare ) are required to follow federal parity madates. 1 Ceters for Medicare & Medicaid Services. The Metal Health Parity ad Addictio Equity Act (MHPAEA). Retrieved from www.cms.gov/cciio/programs-ad-iitiatives/other-isurace-protectios/mhpaea_factsheet.html. 2 NAMI: Natioal Alliace o Metal Illess. What Is Metal Health Parity? Retrieved from www.ami.org/fid-support/livigwith-a-metal-health-coditio/uderstadig-health-isurace/what-is-metal-health-parity Barry, C. L., Huskamp, H. A., & Goldma, H. H. (2010). A Political History of Federal Metal Health ad Addictio Isurace Parity. The Milbak Quarterly, 88(3), 404 433. http://doi.org/10.1111/j.1468-0009.2010.00605.x 3 SAMHSA: Substace Abuse ad Metal Health Services Admiistratio. (2017, Jauary 1). Implemetatio of the Metal Health Parity ad Addictio Equity Act (MHPAEA). Retrieved from www.samhsa.gov/health-fiacig/implemetatio-metalhealth-parity-addictio-equity-act. 1
What is Metal Health Parity? A Cosumer Guide to the Evaluatig State Metal Health ad Addictio Parity Statutes Report However, the Federal Parity Law does ot apply to the followig plas: Tricare, Medicare, Medicaid fee-for-service plas, ad idividual ad group plas that were gradfathered i because they were created prior to March 2010. 4 Health isurace plas CANNOT require higher deductibles, co-paymets, or out-ofpocket expeses for your metal health beefits tha they do for other medical care. Health isurace plas CANNOT limit frequecy of treatmet, umber of visits, or days of coverage for your metal health care more so tha they do for other medical care. Health isurace plas CANNOT review metal health treatmet more frequetly to determie if it is medically ecessary, or use more restrictive criteria for what is medically ecessary tha they do for medical care. 5 Parity ad the Affordable Care Act: The ACA expaded metal health ad substace use disorder beefits ad parity protectios. All marketplace plas made available by the ACA cover metal health ad substace use disorders as essetial health beefits ad caot dey you coverage if you have a pre-existig metal health or substace use disorder. 6 Prior to the passage of the ACA, approximately oe-third of persos covered i the idividual market had o coverage for substace use disorder services ad early 20 percet had o coverage for metal health services, icludig outpatiet therapy ad crisis stabilizatio. 7 4 NAMI: Natioal Alliace o Metal Illess. (2015, October 23). What is Metal Health Parity? Retrieved from www.ami.org/nami/media/nami-media/ifographics/mhparity10-23-15.pdf 5 The Keedy Forum. (2015). Metal Health ad Addictio Parity i Illiois. Retrieved from http://thekeedyforumilliois.org/wp-cotet/uploads/2015/12/summary-of-hb-1-parity-provisios.pdf 6 HealthCare.gov. Retrieved from www.healthcare.gov 7 ASPE Issue Brief. (2011) Essetial Health Beefits: Idividual Market Coverage ed. U.S. Departmet of Health & Huma Services. 2
What is Metal Health Parity? A Cosumer Guide to the Evaluatig State Metal Health ad Addictio Parity Statutes Report State Parity Laws Explaied: While the federal govermet provides overall directio o parity eforcemet activities, states are primarily resposible for moitorig compliace for fully-isured group plas; idividual ad employer-fuded plas of less tha 51 isured employees; Medicaid MCOs; the State Childre s Health Isurace Programs (S-CHIP); ad, i states that have expaded Medicaid uder the ACA, Alterative Beefit Plas. State parity laws vary, ad some require isurace plas to provide more coverage tha the federal law. However, the federal govermet has backup jurisdictio i states that assert they caot eforce or fail to substatially eforce the Federal Parity Law. 8 Our Natio at a Glace: I advace of the 10th aiversary of the sigig of the Federal Parity Law, The Keedy-Satcher Ceter for Metal Health Equity i The Satcher Health Leadership Istitute at Morehouse School of Medicie (KSCMHE), ad The Keedy Forum formed a multidiscipliary research team to develop the Statutory Codig Istrumet (SCI). The SCI assesses state-level metal health parity statutes (writte laws that were passed by state legislatures ad siged by the goveror) usig systematic methods. This study looks at how states pass strog parity statutes i order to make sure that state regulators have a full set of tools to make parity a reality ad to hold both health plas ad state officials accoutable. To read the full report ad dowload your state s report card visit: paritytrack.org/aiversary. Based o the results of the study, 9 the states with the highest grades ad poits for their statutes are Illiois (A, 100), Teessee (C, 79), Maie (C, 76), Alabama (C, 74), Virgiia (C,71), ad New Hampshire (C, 71). However, the laws of most of these higher-scorig states have room for improvemet. The state statutes with the lowest grades ad poits are Wyomig (F, 10), Arizoa (F, 26), Idaho (F, 36), Idiaa (F, 38), Alaska (F, 43), ad Nebraska (F, 43). Wyomig is oteworthy for beig the oly state ot to address metal health parity i its statutory code. 8 Alabama, Oklahoma, Missouri, Texas, ad Wyomig have asserted that their state isurace commissioer lacks the authority uder the curret state laws to eforce the Federal Parity Law (Source: SAMHSA.gov) 9 Douglas, M., Wre, G., Bet-Weber, S., Toti, L., Careal, G., Keeto, T., Grillo, J. Rachel, S., Lloyd, D., Byrd, E., Miller, B., Lag, A., Maderscheid, R., Parks, J. Evaluatig State Metal Health ad Addictio Parity Statutes. The Keedy Forum; 2018. 3
What is Metal Health Parity? A Cosumer Guide to the Evaluatig State Metal Health ad Addictio Parity Statutes Report Figure 1 provides a map of the Uited States that has bee color coded accordig to grades. It should be oted that 43 states received a grade of grade of D or F, with oly seve states receivig a satisfactory grade of C or higher. Table 1 lists the SCI score for each state. Figure 1: Map of the Uited States, Color Coded by Statutory Grades 4
What is Metal Health Parity? A Cosumer Guide to the Evaluatig State Metal Health ad Addictio Parity Statutes Report Table 1. List of States ad State Parity Statutory Score o the Statutory Codig Istrumet State (score) State (score) State (score) State (score) State (score) Alabama (74) Hawaii (67) Massachusetts (61) New Mexico (47) South Dakota (55) Alaska (43) Idaho (36) Michiga (54) New York (53) Teessee (79) Arizoa (26) Illiois (100) Miesota (51) North Carolia (49) Texas (68) Arkasas (59) Idiaa (38) Mississippi (57) North Dakota (48) Utah (58) Califoria (51) Iowa (50) Missouri (63) Ohio (51) Vermot (53) Colorado (70) Kasas (65) Motaa (66) Oklahoma (55) Virgiia (71) Coecticut (60) Ketucky (66) Nebraska (43) Orego (47) Washigto (51) Delaware (57) Louisiaa (51) Nevada (54) Pesylvaia (55) West Virgiia (55) Florida (53) Maie (76) New Hampshire (71) Rhode Islad (67) Wiscosi (52) Georgia (60) Marylad (68) New Jersey (54) South Carolia (50) Wyomig (10) The most commo gaps with state laws had to do with: How metal health ad substace use disorders are defied. How metal health ad substace use disorders are covered. How compliace with parity laws is moitored ad eforced. 5
What is Metal Health Parity? A Cosumer Guide to the Evaluatig State Metal Health ad Addictio Parity Statutes Report The Illiois Example: 10 Illiois parity statute scored 100 o the Statutory Codig Idex. Oe feature of this statute is that the defiitio of metal health ad substace use disorders is tied to the latest expertdeveloped refereces the World Health Orgaizatio s Iteratioal Classificatios of Disease ad the America Psychiatric Associatio s Diagostic ad Statistical Maual of Metal Disorders. The statute also requires the Illiois Departmet of Isurace to proactively eforce state parity law ad collect health plas detailed parity aalyses demostratig compliace prior to pla approval. Fially, though state ad local govermet plas ca opt out of the Federal Parity Law, Illiois applies state parity law to these plas, dramatically expadig the umber of Illiois residets protected by parity. Stregths: Icreased the umber of people beefittig from parity protectio by expadig the types of health plas subject to state parity law, icludig muicipal, couty, ad school district plas, which ca all opt out of complyig with the Federal Parity Law. Strog compliace/eforcemet laguage Opportuity to improve: Lack of requiremets that health plas publicly report data comparig metal health ad addictio claims to physical health claims (though, Illiois established a workig group to make recommedatios i 2019 o what data health plas should be required to report) 10 http://thekeedyforumilliois.org/wp-cotet/uploads/2015/12/summary-of-hb-1-parity-provisios.pdf 6
What is Metal Health Parity? A Cosumer Guide to the Evaluatig State Metal Health ad Addictio Parity Statutes Report Ways to Get Ivolved: ADVOCATE for strog state parity statutes ad regulatios ad SUPPORT FUNDING for state advocacy programs. Legislative Recommedatios Based o Commo Gaps i State Statutes 1. Metal health ad substace use disorders (MH/SUD) must be see as broad as physical health coditios. As such, states should defie MH/SUD to iclude all disorders i the Diagostic ad Statistical Maual of Metal Disorders (DSM) or Iteratioal Classificatio of Diseases (ICD) with o exclusios. 2. Coditios that share the same characteristics should be treated i the same way. As such, co-pays ad out-of-pocket costs, alog with isurer medical maagemet requiremets, must be the same for MH/SUD services as those for physical illesses. States should require that isurace beefit maagemet processes ad treatmet limitatios, specifically both for quatitative treatmet limitatios (QTL) ad oquatitative treatmet limitatios (NQTL), esure parity i coverage. 3. States should stregthe eforcemet ad compliace activities by empowerig regulatory agecies to eforce parity laws, icludig the Federal Parity Law, ad require moitorig agecies to regularly report o steps take to eforce compliace. I additio, states should madate that all health beefit plas submit regular (e.g., aual) aalyses demostratig compliace with the relevat laws. GET INFORMED about your parity rights ad KEEP TRACK of state ad federal parity performace by visitig: www.paritytrack.org. CONTACT your represetatives at the local, state, ad federal levels ad let them kow that parity matters to you. If you thik your health pla is violatig parity, visit www.parityregistry.org to fid out where to go ad to tell us your story. 7
What is Metal Health Parity? A Cosumer Guide to the Evaluatig State Metal Health ad Addictio Parity Statutes Report Notes 8