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Mental health benefits legislation

Health Factors: Access to Care
Decision Makers: Employers & Businesses State Government Healthcare Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 100% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Mental health benefits legislation regulates mental health insurance to increase access to mental health services, including treatment for substance use disorders. Parity, a key part of most mental health benefits legislation, stipulates that health insurance plans have no greater restrictions for mental health coverage than for physical health coverage (CG-Mental health).

Expected Beneficial Outcomes

Increased access to mental health services
Increased substance use disorder treatment
Improved mental health
Reduced suicide

Evidence of Effectiveness

There is strong evidence that mental health benefits legislation that includes parity requirements increases appropriate utilization of mental health services (CG-Mental health) and increases substance use disorder treatment (Wen 2013). Such legislation is also associated with increased access to care, diagnosis of mental health conditions, reduced prevalence of poor mental health, and reduced suicide rates (CG-Mental health). More comprehensive parity laws yield stronger effects (Wen 2013, CG-Mental health).

Parity laws improve financial protection for patients (CG-Mental health) and appear to reduce out-of-pocket spending for mental health or substance abuse treatment for adults with severe mental illness (McConnell 2013), bipolar disorder, major depression, and adjustment disorders (Busch 2013), and families whose children have the highest cost for such care (Barry 2013).

Overall, mental health parity requirements appear to slightly reduce insurers' annual costs per health plan member (CG-Mental health). In an Oregon-based study, however, insurer spending for patients with severe mental illness increased (McConnell 2013). Parity requirements for substance use disorder services do not appear to substantially increase health plan spending (Busch 2014). 

Implementation

United States

The 2010 Affordable Care Act (ACA) named coverage of mental health and substance use treatment as one of the ten essential health benefits; all plans in the individual and small employer market must include this treatment coverage (Goodell 2014). 

The federal Mental Health Parity and Addiction Act of 2008 prohibits insurance plans that offer mental health services from restricting this coverage any more than coverage for physical health services. Plans that cover fewer than 50 employees, or do not offer mental health benefits at all, are exempt from this act. In a 2010 survey, about 2% of employers reported dropping mental health benefits from their coverage to circumvent the act (CG-Mental health).

As of 2014, 49 states and the District of Columbia had enacted some form of mental health benefits legislation (NCSL-Mental health). Large employers that self-insure are exempt from state insurance mandates (CG-Mental health).

Wisconsin

Wisconsin requires group insurers to provide minimum mandated benefits for alcoholism and other diseases as ‘nervous or mental disorders,’ with deductibles and co-pays that are comparable to other health care coverage (NCSL-Mental health).

Citations - Description

CG-Mental health - The Guide to Community Preventive Services (The Community Guide). Mental health. Accessed on December 19, 2016

Citations - Evidence

Barry 2013 - Barry CL, Chien AT, Normand S-LT, et al. Parity and out-of-pocket spending for children with high mental health or substance abuse expenditures. Pediatrics. 2013;131(3):e903-e911. Accessed on January 27, 2016
Busch 2013 - Busch AB, Yoon F, Barry CL, et al. The effects of mental health parity on spending and utilization for bipolar, major depression, and adjustment disorders. The American Journal of Psychiatry. 2013;170(2):180-7. Accessed on January 27, 2016
Busch 2014 - Busch SH, Epstein AJ, Harhay MO, et al. The effects of federal parity on substance use disorder treatment. The American Journal of Managed Care. 2014;20(1):76-82. Accessed on January 28, 2016
CG-Mental health - The Guide to Community Preventive Services (The Community Guide). Mental health. Accessed on December 19, 2016
McConnell 2013* - McConnell KJ. The effect of parity on expenditures for individuals with severe mental illness. Health Services Research. 2013;48(5):1634-52. Accessed on February 1, 2016
Wen 2013* - Wen H, Cummings JR, Hockenberry JM, Gaydos LM, Druss BG. State parity laws and access to treatment for substance use disorder in the United States: Implications for federal parity legislation. JAMA Psychiatry. 2013;70(12):1355-62. Accessed on February 1, 2016

Citations - Implementation

CG-Mental health - The Guide to Community Preventive Services (The Community Guide). Mental health. Accessed on December 19, 2016
Goodell 2014 - Goodell S. Health policy brief: Mental health parity. Health Affairs; April 3, 2014. Accessed on January 28, 2016
NCSL-Mental health - National Conference of State Legislatures (NCSL). State laws mandating or regulating mental health benefits. Accessed on January 28, 2016

Page Last Updated

August 5, 2015

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