ADVANCING MENTAL HEALTH AND ADDICTION PARITY: Addressing the Current Crisis and Reducing Healthcare Costs
Mental Health and Addiction Care Must Be Equal to Medical Care
In 2008, President George W. Bush signed a landmark piece of legislation. Thefederal parity law requires health insurers that offer mental health and addiction benefits to do so on par with medical and surgical benefits. Health insurers and managed care organizations can no longer apply financial requirements and treatment limitations that are more restrictive for mental health and addiction benefits than those applied to medical and surgical services. The federal parity law applies to most commercialand to all Medicaid Managed Care plans in America, and state insurance commissioners and Medicaid Directors have the authority to enforce it.
Parity Enables Access to Timely and Appropriate Care
Like the many other states, [Insert State] faces a growing epidemic of opioid addiction and overdose. [Insert state specific opioid statistic- i.e., 600 Floridians died of an opioid overdose in 2016.] The parity law is one way to ensure that health plans are playing a role in addressing the current crisis, providing insured individuals timely access medically appropriate care.
Unfortunately,more than three years after the final parity regulations were promulgated, the law’s protections designed to safeguard individuals and health care providers from unfair restrictions remain unrealized. Individuals and their employers are still paying for insurance coverage of mental health and addiction care that is far more restrictive than insurance coverage of other medical care. This includes:
- more restrictive treatment limitations;
- more stringent and frequent authorization requests;
- fail-first or step therapy requirements for more intensive levels of services or prescription drug access; and
- more restrictive policies and procedures for paneling providers in provider networks and determining reimbursement rates.
These barriers result in care delays, denials for service,and often create a crisis situation for individuals and their families.Individuals who use their insurance to access mental health and addiction care experience these barriers far more frequently than individuals who access medical services, such as chemotherapy and dialysis.Research shows that untreated mental illness and addiction causes an increase in hospital readmissions, a need for more intensive and costly types of care, as well as an inability to manage other chronic medical conditions, increasing the cost burden on the entire health care system.
Strong Parity Enforcement Means that Individuals Can Access What is Contractually Promised
The purpose of [Insert bill number] is to facilitate implementation and enforcement of the federal parity law and strengthen parity provisions within [Insert State] law.Improved enforcement of the parity law will ensure that individuals are able to access the benefits that they and their employers are paying for with their premium dollars. Each section of this legislation targets critical areas that must be addressed to ensure that coverage for mental health and addiction care is comparable to coverage for other medical conditions.
The attached document explains each section of the legislation in terms of its intent and why it is necessary.[Insert name of organization] urges your support for [insert bill number] because our clients continue to struggle with discriminatory insurance coverage of their mental health and addiction benefits and [insert name of citizenry, i.e. Floridians] deserve equitable coverage for their premium dollars.
If you have questions or would like more information, do not hesitate to contact [Insert name and contact info].