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Mental health and addiction treatment experts praised what they described as a “historic” expansion Friday of insurance coverage for millions of Americans suffering from psychological or substance abuse problems, five years after a law requiring the coverage first passed.
But they also said they’ll be waiting to see whether a federal final rule that requires insurers to regard mental health and addiction problems on par with other illnesses actually lives up to its promises.
“This has been anxiously and long awaited,” said Dr. Jeffrey Lieberman, president of the American Psychiatric Association. “Everything we’ve heard gives us a lot of encouragement. We just hope the rule goes far enough.”
Health and Human Services Secretary Kathleen Sebelius announced in Atlanta that the administration would later on Friday post the long-awaited rule establishing parity for mental health and substance use disorders, a key feature already implemented in the 2010 Affordable Care Act.
"This is the largest expansion of behavioral health coverage in a generation," Sebelius said.
The rule guarantees that health plans’ co-payments, limits on visits to providers and deductibles for mental health benefits match those for medical and surgical benefits. It also ensures equal treatment for residential and outpatient care, a long-sought benefit in the mental health community.
The rule could affect 62 million Americans, including about 23 million Americans who meet the criteria for substance abuse disorder, administration officials said.
“For way too long, the health care system has openly discriminated against Americans with behavioral health problems,” Sebelius told reporters on a call after the announcement.
The new rule implements the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.
Addressing the need for adequate care for mental health has been a goal for more than 50 years, when President John F. Kennedy first publicly advanced a plan to address what was regarded largely as a shameful secret.
People affected by mental illness have “suffered in silence, stepchildren of the health care system,” U.S. Labor Secretary Tom Perez told reporters.
The practical effect of the new law, which applies to all types of insurance, will be new and broader access to care, said Cynthia Moreno Tuohy, executive director of the National Association of Alcoholism and Drug Abuse Counselors (NAADAC).
“What it means for us is that we should see more people coming into the treatment world,” Tuohy said. “One of the reasons people don’t come into treatment is that they don’t have health care. This takes those barriers away.”
With access to coverage, more people with mental health and substance abuse problems may seek care earlier, before they escalate, she added.
Still, experts said they were waiting to scope out the details included in the new federal rule. At issue will be the criteria insurers use to include – or exclude – someone for mental health and addiction coverage.
For example, many insurers now refuse to cover addiction treatment if a person is arrested for driving under the influence, Tuohy explained.
“The reason they got the DWI is because they need treatment,” she said. “We blame them and then we stigmatize them for getting the treatment that they need.”
Lieberman said APA experts would review the new rule carefully, looking to see how transparent insurers will be required to be about their coverage criteria – and how the new rule would be enforced.
“It would be naïve to think insurers would take this lying down,” he told NBC News, adding that some providers might try to “rope-a-dope,” or evade, the requirements.
But America's Health Insurance Plans, a national trade group for insurers, said their members, too, support the changes.
"Helping patients get the care they need for physical, mental, and behavioral health conditions has been a top priority for our industry," Karen Ignagni, the group's president said in a statement. "Health plans have long supported the Mental Health Parity and Addiction Act and have worked to implement these requirements in a manner that is affordable, safe, and effective for patients. We appreciate that the final rule enables patients with mental and behavioral health conditions to continue to benefit from the innovative programs and services health plans have pioneered."