Employers Adjusting to Mental-Health Parity Act

New regulations that prohibit large health plans from setting higher co-payments or limiting doctor visits for mental-health care are leading some organizations to drop mental-health benefits altogether. That's a "very, very" bad idea, experts say.

By Kristen B. Frasch

With the new requirements of the Mental Health Parity and Addiction Equity Act going into effect at the start of 2011, many organizations are now making adjustments to comply and to avoid prohibitive cost increases.

Some -- primarily employers with less than 200 employees, according to the Kaiser Family Foundation's 2010 Employer Health Benefits survey -- are even dropping their mental-health benefits altogether.

The survey, conducted by the Menlo Park, Calif.-based foundation, which polled U.S. firms with more than 50 workers, found about one-third made changes in the benefits they offer in order to respond to the law, and 5 percent dropped them from their healthcare packages. Broken down however, that total 5 percent represented 7 percent of firms with fewer than 200 employees and only 2 percent with 200 or more.

That seems to bear out with the National Business Group on Health's findings from a summer survey it conducted of its 300 members, primarily Fortune 500 companies and large public-sector employers?including healthcare purchasers?that provide health coverage for more than 50 million U.S. workers, retirees and their families.

None of those respondents said they would be dropping their mental-health benefits, but 89 percent said they would be adjusting them in response to the law, says Steve Wojcik, vice president of public policy for the Washington-based organization.

The Parity Act, which was signed into law in 2008, prevents large health plans from setting higher co-payments for mental-health visits than those for medical visits, or limiting doctor visits for mental-health care, among other things.

Most of the adjustments NBGH members are making, says Wojcik, are in reductions of the cost-sharing responsibilities for employees for mental-health providers. One-third of respondents, he says, "are lowering the mental-health co-payment to equal that for the medical side." Fourteen percent, however, are increasing their medical co-payments for employees "to equal the mental-health side of the party equation," he adds.

"Luckily, I haven't heard of a single [NBGH member] dropping mental-health benefits," Wojcik says, "but I am hearing a lot of questions about 'How do we maintain parity to comply?' "

The larger employers not only are in a stronger position to support the mental-health portions of their healthcare plans, he says, "they also get it -- they understand the importance of mental-health care for the company's overall productivity and even cost benefits" of the overall health plan.

"They seem to understand that if you eliminate it altogether," Wojcik says, "you might pay more on the other end, through necessary prescriptions."

Mental-health benefits, he says, "can not only help with maintenance medication, but with overall workforce issues such as productivity, absenteeism, presenteeism, even other medical costs."

In some healthcare issues, he says, "if you don't treat the depression [or other underlying mental ailment], then you're impacting medication compliance, overall wellness and healthy lifestyles, etc.," those things that can have a much greater impact on the workforce as a whole.

In fact, NBGH heavily promotes integrating mental health and medical benefits through clear and constant communication between the patient and all physicians involved, mental and medical, says Wojcik. It also stands behind the argument for better integration of medical records, including online, so care providers and physicians are fully aware of all the treatments and medicines affecting any one patient at any time.

"If this report from Kaiser indicates some organizations are beginning to drop mental-health benefits altogether [which it does, primarily for smaller and mid-sized companies]," he adds, "our experience shows this is a very, very bad idea."

See related column by Carol Harnett: The Screen Actors Guild Abandons Mental-Health Benefits

Jan 17, 2011
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