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Mental Health Parity
Mental Health Parity.


by Virginia R. Wittig



Probably the most far-reaching legislation that affects nurse therapists today is that of mental health parity. Officially designated "The Decade of the Brain," the 1990s brought unprecedented federal and state legislation to end health insurance discrimination against individuals with mental illnesses.


Federal Parity


Mental Health Parity Act of 1996. The Mental Health Parity Act of 1996 became effective January 1, 1997, and will sunset on September 30, 2001. It requires employers that offer mental health benefits to set annual and lifetime caps equal to those for medical and surgical benefits. The measure excludes businesses with 50 or fewer employees, and allows all employers to be exempted from the law if their costs rise more than 1% as a result of complying with the requirements. The law allows health insurance plans to set different benefit levels for copayments, deductibles, out-of-pocket payments, inpatient hospital days, and outpatient visits.


Relationship to state law. A state law requiring more comprehensive coverage is not weakened by the federal parity law, nor does the federal law preclude a state from enacting stronger parity legislation.


On April 14, 1999, U.S. Senators Pete Domenici (R-NM) and Paul Wellstone (D-MN) introduced the Mental Health Equitable Treatment Act of 1999, which would require full health insurance parity for the most severe, biologically based mental illnesses. This legislation would prohibit unequal restrictions on annual and lifetime mental health benefits, inpatient hospital days, outpatient visits, and out-of-pocket expenses. Variations and amendments to this federal bill are being considered.


Overview of State Parity Laws


After the Mental Health Parity Act of 1996 was signed into law, the momentum shifted to the states. A firestorm of legislative activity created a patchwork quilt of various parity laws around the country. A total of 28 states now have some degree of mental health parity, with fairness bills pending in many other state legislatures.


Depending on the state, mental health parity may include any combination of the following two items:


1. Equalization of insurance benefits in relation to annual and lifetime caps


2. Equalization of benefit levels for copayments, deductibles, out-of-pocket payments, inpatient hospital days, and outpatient visits.


In 1999, 11 states (California, Hawaii, Indiana [expansion of '97 law], Louisiana, Missouri [expansion of '97 law], Montana, Nebraska, Nevada, New Jersey, Oklahoma, Virginia) and two territories (Guam, Puerto Rico) passed parity legislation.


In 1998, four states (Delaware, Georgia, South Dakota, Tennessee) passed parity legislation.


In 1997, nine states (Arizona, Arkansas, Colorado, Connecticut, Indiana, Missouri [managed care only], South Carolina, Texas [expansion of earlier requirement], Vermont) passed mental illness parity legislation.


Between 1991 and 1996, seven states (Maine, Maryland, Minnesota, New Hampshire, North Carolina [state employees only by administrative order], Rhode Island, Texas [state employees only]) effected mental illness parity measures.


As each state passes some form of parity legislation or expands existing law, managed care networks are opening up to accept additional therapists to handle the increased workload. The NAMI website gives a state-by-state breakdown of mental illness parity laws. At this site it is possible to find out the specific provisions each state has passed, if any, and when the law has or will become effective.


If you reside in a state that has recently passed or amended parity legislation, you are in a window of opportunity that will not last long. Once networks reach their provider quotas, it will be very difficult to gain entry. To take advantage of this window of opportunity, here are several steps you can take:


1. Find out which managed care organizations hold contracts in your geographic area. Call long-established therapists who hold managed care contracts and find out which networks they are in. Or call local businesses directly and ask their EAPs or Human Resources Department which managed care companies provide their mental health services.


2. Check the Web site for the National Committee for Quality Assurance, www.ncqa.org. The NCQA accredits managed behavioral healthcare organizations and maintains an MBHO Accreditation Status List. Look for the list under the NCQA Provider Page, Information about NCQA's Programs, Managed Behavioral Health Care Organizations (MBHOs).


3. Once you have gathered the names of several regional, state, and national managed care companies that deliver mental health services (most companies have a toll-free number), ask for provider relations. If they are accepting new providers, request an application be sent to you. Some may ask for a written letter of request for the application. If so, include a cover letter briefly emphasizing key reasons why you in particular would be a good provider. Examples may include:


a. Extensive background working with the chronically mentally ill in an inpatient setting


b. Training and experience monitoring psychotropic medications


c. Experience/training/certification in chemical dependency counseling for the dually diagnosed


d. Training/experience using brief therapy principles/cognitive behavioral strategies


e. Specialization in geriatric/adolescent psychiatry, or specialization in specific diagnostic areas such as major depression, working with flashbacks or hallucinations, etc.


f. Willingness and ability to be a good team member, such as ability to see new referrals in 72 hours, timely referrals for medications if needed, ability to effect positive change in a limited number of outpatient visits, prompt completion and return of paperwork (excellent documentation for NCQA audits)


4. In addition to a cover letter, most companies require a copy of your license/certification and malpractice insurance, and a resume.


5. When you receive the application, pay particular attention to sections that ask about your availability and the number of sessions it takes you to complete therapy. Be generous with your availability--this is an important determinant for referrals. Availability does not mean you are sitting in your office all the hours that you list, but that you will see a referral during those hours. The number of sessions is based on all cases. Include your one-session cases to determine your average; the number should fall in the range of 8 to 15. Offer an explanation if your average exceeds that (e.g., 50% of clients have eating disorders, are chronically mentally ill, etc.).


It is worth applying to a full range of managed behavioral healthcare organizations because they continue to consolidate and merge. Joining a small regional or state company can place you in a larger state or national company over time. Once you are credentialed as a provider, you are not restricted to providing services for biologically based mental illness only.


To get started, here are a few national managed care companies that may be accepting new providers in your area:


* ValueOptions: 800.336.9117 (ask for the 800 number for provider relations in your state)


* Managed Health Network: 800.374.3707


* United Behavioral Health Managed Care Network (formerly U.S. Behavioral Health): 799.332.8724


Questions? Please E-mail me at [email protected], with a copy to the Editor: [email protected]


Key words: Managed care, parity laws, parity legislation


Virginia R. Wittig, MN, RNCS has a private practice in Woodland Hills, CA.
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