November 8, 2013 proved a landmark day for those with mental health issues in the United States. Finally, the Mental Health Parity and Addiction Equity Act went into effect. This federal law was passed in 2008 and was designed to ensure that insurance companies provided the same coverage to psychiatric illnesses and substance-abuse disorders as they routinely extended to physical illness.
All of us in the behavioral health field celebrated when the initial law was passed, hoping that it finally meant that people in need could get the treatment they deserved. Little did we know that implementation, due to myriad reasons, would be so profoundly delayed – a full five years.
What does mental health parity mean in plain language? It means that those struggling with an eating disorder, chemical addiction or any other psychiatric illness can receive the same insurance coverage as those dealing with a physical disease such as cancer. It is intended to mean equality.
For the past five years, without a final implementation rule from Congress, parity has come to mean many things to many different people. Unfortunately, “parity” has been improperly used by payors at times to deny access to care for those with mental illness. Equal does not mean the same. It would be ludicrous to apply the exact same medical necessity criteria for a person with congestive heart failure needing inpatient treatment to a person needing inpatient or residential treatment for depression or an eating disorder. A good example of this is when a person with an active eating disorder, purging multiple times a day but with normal vital signs and labs, is denied residential treatment solely based on the fact that her labs, vital signs and weight might be within normal limits for that day.
Ultimately each state has an executive board responsible for holding providers and payors accountable to be operating within the law of parity. Some states do this better than others. We commend all of those responsible for moving the thought of parity further along into reality. Additionally, we encourage everyone to get the help they require to get well.