Sonoma County, California 94952, United States
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System change
Mental Health Parity
What is mental health parity?
Mental health parity describes the equal treatment of mental health conditions and substance use disorders in insurance plans. When a plan has parity, it means that if you are provided unlimited doctor visits for a chronic condition like diabetes then they must offer unlimited visits for a mental health condition such as depression or schizophrenia.
However, parity doesn't mean that you will get good mental health coverage. Comprehensive parity requires equal coverage, not necessarily "good" coverage. If the health insurance plan is very limited, then mental health coverage will be similarly limited even in a state with a strong parity law or in a plan that is subject to federal parity.
In 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) to ensure equal coverage of treatment for mental illness and addiction.
In November 2013, the federal government released rules to implement the law. Before this law, mental health treatment was typically covered at far lower levels in health insurance policies than physical illness.
Whether or not a plan is covered by federal parity law depends on the kind of health plan a person is enrolled in and even its size.
2020
SB 855 (Weiner ) Passed Sept 25 2020
This bill repeals California’s mental health parity law and replaces it with a broader requirement on health plans and disability insurers to cover medically necessary treatment of mental health and substance use disorders under the same terms and conditions applied to other medical conditions; establishes new requirements for medically necessary care determinations and utilization review; and bans discretionary clauses in health plan contracts.
This bill requires a health care service plan contract or disability insurance policy issued, amended, or renewed on or after January 1, 2021, to provide coverage for medically necessary treatment of mental health and substance use disorders, as defined, under the same terms and conditions applied to other medical conditions. The bill would prohibit a health care service plan or disability insurer from limiting benefits or coverage for mental health and substance use disorders to short-term or acute treatment. The bill would revise the covered benefits to include basic health care services, as defined, intermediate services, and prescription drugs.
Resources
WHAT IS MENTAL HEALTH PARITY?
Fact Sheet: 2 pages
Disability Rights CA
California mental Health Services Authority( CalMHSA)
KNOW YOUR RIGHTS - You have the right to coverage for the diagnosis and medically necessary treatment of mental illness. - You can change your doctor or other mental health provider if you are not satisfied. - You can see and get a copy of your medical records. - You have the right to keep your medical information private. - You can get a second medical opinion when you are given a diagnosis or treatment option.
Q: What must be equal for mental and physical health?
A: Co-payments, co-insurance, deductibles, out-of-pocket expenses, any treatment limitations, prior authorization requirements, frequency of treatment, access to medications, number of visits, and days of coverage.
Q: What are some examples of unequal coverage?
A:
1) Your insurance will only pay for one session of mental health therapy a month but your insurance will pay for more visits to other physical health providers.
2) Your insurance will pay for outpatient programs after a car accident but not after a mental health crisis.
3) You have to pay $40 every time you see a mental health provider but only $20 when you see other health providers.
FEDERAL PARITY LAW
Q: Which insurers are obligated?
A: Beginning January 1, 2014, the Affordable Care Act (ACA) expands The Mental Health Parity and Addiction Equity Act of 2008 to apply to almost all forms of health insurance. In addition to large group employer plans and state regulated plans, including Medi-Cal managed care plans, the ACA will require all small group and individual market plans to comply with federal parity requirements, including Medicare Advantage and health plans offered through the insurance exchange, Covered California.
Q: What benefits must be provided?
A: The ACA strengthens the 2008 parity law by requiring health insurers to include coverage for mental health and substance use disorder services because they are now considered an Essential Health Benefit.
CALIFORNIA PARITY LAW
Q: Who does the California parity law apply to?
A: California’s mental health parity law, Mental Health Parity Act of 1999, AB 88 applies to California’s private insurers that are state regulated. The law does not apply to Medicare, Medi-Cal, Veterans Administration programs, or self-insured health plans (usually large employers whose plans are regulated only by federal law). Additionally, California law limits equal coverage to the following mental health conditions: Major depression; Bipolar (manic-depressive) disorder; Panic disorder; Anorexia; Bulimia; Obsessive-compulsive disorder; Autism or Pervasive Developmental Disorder; Schizophrenia; Schizoaffective disorder; and Children's severe emotional disturbances.
Q: What benefits must be provided under California law?
A: Outpatient services, inpatient hospital services, partial hospital services, prescription drugs (if included in plan). Also, the 9th Circuit Court found that a health plan should provide all “medically necessary treatment” for “severe mental illnesses” such as residential care. Harlick v. Blue Shield of California, 686 F.3d 699 (9th Cir. 2012).
Q: How are the parity laws enforced?
A: The agencies regulating the plans will be responsible. These include the California Department of Managed Health Care, the California Department of Insurance, and the Department of Labor.
Disability Rights California is funded by a variety of sources, for a complete list of funders, go to http://www.disabilityrightsca.org/ Documents/ListofGrantsAndContracts.html.
The California Mental Health Services Authority (CalMHSA) is an organization of county governments working to improve mental health outcomes for individuals, families and communities. Prevention and Early Intervention programs implemented by CalMHSA are funded by counties through the voter-approved Mental Health Services Act (Prop 63). Prop. 63 provides the funding and framework needed to expand mental health services to previously underserved populations and all of California’s diverse communities.
Behavioral Health Parity and the Affordable Care Act
Richard G. Frank, Ph.D., Professor, Kirsten Beronio, J.D., Division Director, and Sherry A. Glied, Ph.D., Dean
Abstract
Prior to the passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) and the ACA, about 49 million Americans were uninsured. Among those with employer sponsored health insurance, 2 % had coverage that entirely excluded mental health benefits and 7% had coverage that entirely excluded substance use benefits. The rates of non-coverage for mental and substance use disorder care in the individual health insurance markets are considerably higher. Private health insurance generally limits the extent of these benefits. The combination of MHPEA and ACA extended overall health insurance coverage to more people and expanded the scope of coverage to include mental health and substance abuse benefits.
Keywords: co-occurring disorders, disability economics, disability policy, health care, mental health, mental illness, policy, substance abuse
Affordable Care Act (ACA)
The comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”).
The law has 3 primary goals:
- Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level.
- Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. (Not all states have expanded their Medicaid programs.)
- Support innovative medical care delivery methods designed to lower the costs of health care generally.
Related content
AB 88 Mental Health Parity Act 1999
AB 88 Mental Health Parity Act 1999
"This bill would require a health care service plan contract or disability insurance policy issued, amended, or renewed on or after July 1, 2000, to provide coverage for the diagnosis and medically
necessary treatment of severe mental illnesses, as defined, of a person of any age, and of serious emotional disturbances of a child, under the same terms and conditions applied to other medical
conditions.
This bill would allow a health care service plan or disability insurer to provide the required mental health coverage through a separate specialized health care service plan or mental health plan subject to certain conditions, as specified.
The bill would exempt from the provision relating to a health care service plan contract, a contract between the State Department of Health Services and a health care service plan for enrolled Medi-Cal
beneficiaries.
The bill would exempt certain insurance policies from these provisions.
Snapshot of the Implementation of California's Mental Health Parity Law
March 2020
34 Pages
California Health Care Foundation
Prepared by Mathematica Policy Research Inc
The expansion of mental health benefits under AB 88 is intended to increase access to and qualty of services for people with SMI and SED
Severe mental Illness (SMI) including schizophrenia, schizoaffective disorder, bipolar disorder( manic depressive illness), major depressive disorder, obsesive -compulsive disorder, pervasive developmental disorder or autism, anorexia nervosa and bulimia nervosa
Serious Emotional Disturbance( SED) of a child other than a primary substance abuse disorder or developmental disorder,that result in behavior inappropriate to the child's , according to expected child development norms.
Washington State’s Transition to Integrated Physical and Behavioral Health Care
Case Study:
September 2020
(7 pages)
Washington State’s Transition to Integrated Physical and Behavioral Health Care
https://www.chcs.org/media/WA-BH-Integration-Case-Study_091620.pdf
Youth and Traitional Age Youth (TAY)
Additional Information
Youth Survey data . https://www.pressdemocrat.com/article/news/rise-in-mental-health-crises-among-sonoma-county-youth-a-growing-concern/?sba=AAS
Latino Service Providers: Youth Promotoras
