Nineteen years ago, the Mental Health Parity Act was signed into law. It was a relatively small, but still important, step forward, making sure caps on mental health benefits were on par with those more medical/surgical health benefits. Seven years ago a bigger step forward was made with the passage of the Mental Health Parity and Addiction Equity Act. This measure required group health plans and health insurance issuers to make financial requirements (such as co-pays and deductibles) and treatment limitations (such as visit limits) no more restrictive for mental health and addiction services than for medical/surgical services. Then, five years ago, as part of the ACA, these requirements were extended to also apply to individual coverage. Most recently, CMS proposed a rule extending these requirements to Medicaid and CHIP. In addition to the federal mental health parity requirements, all states, with the exception of Wyoming, have mental health parity laws of their own.
While all of the foregoing were considered big wins by mental health providers and advocates, mental health parity nonetheless has often existed more on paper than in practice. That may be on the verge of changing. In a recent 2nd Circuit decision, New York State Psychiatric Association, Inc. v. UnitedHealth Group, there are signs that mental health parity laws may be enforced more easily than previously thought. In a nutshell, a mental health provider association was determined to have standing to raise a claim against an insurer. Given the hurdles, financial and otherwise, that would face an individual provider or beneficiary seeking enforcement of mental health parity, this decision has been hailed as groundbreaking.
In addition, there is strong bipartisan support in both houses of Congress for additional federal legislative action on mental health. Despite the onslaught of presidential politics and a belief that legislating may largely be done until after November 8, 2016, there is talk among not only advocates but also prominent lawmakers that further federal action on mental health is going to happen this year. While the measures before Congress are likely to be fine-tuned, especially in response to differing approaches to HIPAA concerns, it is likely that they would not only strengthen parity requirements further but that there also would be additional funding for mental health services.
In the House, Tim Murphy (R, PA) is leading the charge with his Helping Families in Mental Health Crisis Act of 2015. This bill has 128 cosponsors (89Rs, 39Ds) and already had a hearing this summer in the powerful Energy & Commerce Committee. In the Senate, the closest parallel bill is the effort by Chris Murphy (D, CT) and Bill Cassidy (R, LA) to pass the Mental Health Reform Act of 2015. Also in the Senate, though, the HELP Committee has already voted through the Mental Health Awareness and Improvement Act of 2015. While this bill does not have the scope of the other legislation mentioned, its unanimous support in the HELP Committee demonstrates the Congressional appetite for moving ahead on mental health despite a deep divide among Members on many other issues.
Unfortunately, there is no shortage of high-profile tragedies to highlight the dangers that can accompany some types of mental illness, the latest being the shooting in Oregon this week. While gun control legislation may not come out of this event, let us hope that it adds some momentum to truly strengthen our mental health system. Were we to see stronger enforcement of existing mental health parity laws and even more comprehensive legislation, true mental health parity may finally be on the horizon.