New mandate ensures that plans cover mental health and addiction services in the same way they treat other medical issues.
By Jamison Monroe, Jr.
Last month, the mental health community was given some much needed relief when the Obama Administration implemented the final rule be put in place from 2008’s Mental Health Parity and Addiction Equity Act. The new mandate will ensure that most health plans cover mental health and addiction services in the same way they treat other medical issues.
This ruling was long overdue and only further highlights the friction between the mental health community and insurance companies who have resisted covering mental illness. Now, after a 5-year delay, mental health parity is defined clearly to insurance providers. In other words, people who may be suffering from bipolar disorder can walk into a doctor’s office and receive the same care someone who caught the flu would get.
And while we have all had the flu or gone to the doctor for a check-up, mental illness is more prevalent than some realize.
According to statistics from the National Institute of Mental Health (NIMH), one in four adults live with a mental illness. This makes it the leading cause of disability in the United States.
Even though the data might show that mental health issues are more common than most Americans think, most people don’t get treated due to the intense stigma surrounding the illnesses.
Stigma added to the cost of treatment is a dangerous combination that leaves many to forgo care. NIMH concluded that mental health services for adults cost on average of $1,591. For kids, the price is higher with an average of $1,931.
Let’s not leave out those who also struggle with substance abuse problems. The Substance Abuse and Mental Health Services Administration estimates that 23 million Americans go through addiction issues. This number is only rising because of the lack of preventive services. In fact, I was one of them.
I currently operate Newport Academy, a teen and young adult treatment facility with a location in Southern California and now, in Connecticut. I opened the East Coast center because of the overwhelming response I received from families who needed to send their kids for care, but couldn’t find any local rehabs in their region.
For a lot of Americans, treatment programs are not cheap and in our current economic times, many families are faced with some tough decisions. Only about 11% of individuals who need treatment get care.
I believe that under both the expanded parity rules as well as the Affordable Care Act, healthcare providers and investors will be more open to operating mental health centers.
My hope is that with the new parity rule, it will help feed a void for more facilities to open in areas that need accessible and affordable treatment centers-not only for specifically substance abuse, but also for all mental illnesses.
Jamison Monroe, Jr., CEO of Newport Academy located in Southern California and Connecticut.
In this episode of the "Meet the Board" podcast series, Briana Contreras, Managed Healthcare Executive editor, speaks with Ateev Mehrotra, a member of the MHE editorial advisory board and a professor of healthcare policy and medicine at Harvard Medical School. Mehtrotra is also a hospitalist at the Beth Israel Deaconess Medical Center in Boston. In the discussion, Contreras gets to know Mehrotra more on a personal level and picks his brain on some of his research interests including telehealth, alternative payment models and price transparency.
Listen
Inflation Reduction Act: Reforms to Patient Cost-Sharing
September 18th 2023Lower out-of-pocket costs for patients might put upward pressure on drug prices, as manufacturers face less price sensitivity, note Matthew Majewski and Rhett Johnson of Charles River Associates. But they also note that upward pressure on price is likely to be limited to the inflation rate as any additional price increase would need to be paid back to CMS in the form of inflation rebates.
Read More
Spending climbed by 2.7% in 2021. In 2020, it soared by 10.3%, fueled by federal government spending in response to the pandemic. The blizzard of calculations of 2021 healthcare spending by CMS’ actuaries also provides further evidence that utilization of healthcare services bounced back in 2021.
Read More
Talking PIE, the Act, Before Thanksgiving
November 23rd 2022AMCP CEO Susan A. Cantrell spoke with Managed Healthcare Executive® about Preapproval Information Exchange (PIE) Act of 2022, which would allow drug manufacturers to share information about a drug with payers before the drug is approved. Cantrell says passage of the PIE Act would speed up patient access to new medications.
Read More
Inflation Reduction Act and the Impact on Pharmaceutical Pricing and Investment Decisions
November 21st 2022The reference to “maximum fair price” in the act bodes poorly for manufacturers and suggests more of a take-it-or-leave-it situation rather than a negotiation where clinical evidence would be the prevailing factor in determining price.
Read More