Mental-health care for thousands of Montanans covered by group health insurance plans will be more affordable in 2010 thanks to a new federal law.
Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act in October 2008 as part of the multibillion-dollar federal bailout package.
The law, which took effect Jan. 1, prevents insurance plans that cover treatment for mental illnesses and addictions from placing stricter limits on those services than on other covered services. It does not require plans to cover treatment for mental health and substance abuse.
It had been common for insurance carriers to limit the number of visits to mental-health providers allowed in a year or to place monetary caps on inpatient treatment for mental disorders or addictions while placing no such limitations on other types of care.
“The main way to look at this legislation is as part of the process of our society realizing it doesn’t make sense and is not just to treat brain disorders differently from other disorders,” said Matt Kuntz, executive director of the Montana chapter of the National Alliance on Mental Illness.
“Long term, the goal is true and total parity from all plans without exemptions, but it’s going to take a bit to get there,” Kuntz said.
The federal parity act applies to all group health insurance plans that cover employees of businesses with more than 50 workers.
Smaller companies can opt out, as can local and state governments.
Most insurance carriers who have filed 2010 paperwork with the state Commissioner of Securities and Insurance office are in compliance with the parity law, a spokeswoman said.
“For those companies not in compliance, we are sending an objection report and companies willingly file corrected forms,” the state’s insurance commissioner, Monica Lindeen, said in a prepared statement.
So far, there is no sign of companies opting to drop coverage rather than make it equal, Lindeen’s office said. That’s likely due to a Montana law that requires group health plans to provide some coverage for major mental illnesses.
Meanwhile, many 2010 plans have been improved.
Billings Clinic removed coverage limits from the plans it offers to employees.
“Mental health will be in parity with the medical benefits we offer,” said Mary Ellen James, the hospital’s human resources manager.
The city of Billings also changed its mental-health benefits to bring them in line with the federal law, even though it was not required to do so.
“We believe in the long run that will benefit the plan,” said Karla Stanton, manager of the city’s human resources department. “If you don’t treat mental issues, it can affect the physical. We’ll be treating things sooner than we might have before.”
Some limits remain in place for addiction treatment under city plans, Stanton said.
More than 9,000 educators who are insured through the Montana Unified School Trust also will see a change in their benefits.
Limits on chemical dependency treatment will be lifted when the trust’s health plans renew on July 1. Mental health was already covered equally.
“It all comes down to the philosophy of our plan and the intent of our board,” said Bob Robinson, the trust’s CEO. “This is a need. … They’ve always been looking at what we can do to take care of our members rather than how we can not pay for some benefits.”
The state of Montana chose not to adopt the federal guidelines this year, said Connie Welsh, a benefits administrator in the Department of Administration.
About 50,000 Montanans work for the state government or in the state university system.
“Montana was pretty progressive back in the ’90s,” Welsh said. “Our mental-health benefits exceed what the federal regulations require and have for probably a decade.”
Welsh said state plans do place caps on treatment for substance abuse, but that policy is under review.
Businesses that do not comply with the parity act face federal tax penalties. Consumers who think their plan is not in compliance should contact the state insurance commissioner, the federal Department of Health and Human Services or their member of Congress.
Advocates hope the parity act set a minimum standard for the way mental health and substance abuse coverage will be addressed in health care reform.
“The passage of the Wellstone-Domenici act elevated the importance of mental health in our overall health care debate,” said Steve Vetzner, a spokesman for the advocacy group Mental Health America. “It did provide a platform.”
Contact Diane Cochran at firstname.lastname@example.org or 657-1287.