Mental Health Parity & Consumer Tools
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Mental Health Parity & Consumer Tools Trevor Summerfield Manager of Federal Policy American Foundation for Suicide Prevention www.afsp.org
Transcript of Mental Health Parity & Consumer Tools
Mental Health Parity & Consumer Tools
Trevor Summerfield
Manager of Federal Policy
American Foundation for Suicide Prevention
www.afsp.org
Why mental health care is
important to your constituents
Mental Health Parity Consumer tools
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2005
•133 Americans, almost 1 in 2 adults, had at least one chronic illness. •10-65% had co-occurring behavioral
health conditions •Most common - Depression
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Passed in October 2008
Final rules issued on November 8, 2013
Seeks to eliminate discriminatory access to mental health (MH) and substance use disorder (SUD) benefits
Plans subject to the federal parity law are precluded from offering MH and SUD benefits in a more restrictive way than other covered medical and surgical benefits.
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Parity prohibits • Limitations to MH and SUD benefits that are more
restrictive than medical/surgical benefits • Limitations include: • Quantitative treatment limitations such as
day/visit limits or frequency/treatment limits • Non-quantitative treatment limitations such
as medical management tools
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•Comparison of MH/SUD & medical/surgical benefits
•Treatment limitations • Financial requirements
Parity Analysis
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Evolution Applied to large group health plans and
Medicaid managed care plans – 2008
Extended to CHIP – 2009
ACA extends parity requirements to individual and small group markets and Medicaid Alternative Benefit Plans
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Enforcement
•States primary means of enforcement
•CMS – authority over states that don’t comply
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Plan Selection Tool
Accessing Your Health Plan Choices
1: Type https://www.healthcare.gov/families/ into your internet web browser 2: Click the “Apply Now” button 3: Select your state from the drop-down menu 4: Click the button that says “Apply Now” or that redirects you to the state’s web site 5: Fill out the application to find your health plan choices
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Quick Facts on MH Parity Putting This Knowledge into Practice
• Your health insurance plan is required to cover mental health and substance use
benefits. You should know: • What benefits your plan covers. • How to access benefits that your plan restricts or does not cover.
• Be able to identify whether your health insurance coverage includes limits on the
mental health and substance use disorder services or medications you need. • Learn about the tools you can use to apply for and obtain coverage for services
you need.
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Patient Empowerment Tools Summary of Benefits and Coverage–This document will give you information about coverage of mental health and substance use disorder benefits. Find the section called, “If you have mental health, behavioral health, or substance abuse needs.” In the “Limitations & Exceptions” column, you will see if any limitations or exceptions apply to these benefits.
Formulary–The formulary is the list of medications your plan covers. The marketplace website should provide a link to each plan’s formulary. Look up whether each of the medicines you use is covered by the plan.
Mental Health Parity & Consumer Tools
Trevor Summerfield
Manager of Federal Policy
American Foundation for Suicide Prevention
www.afsp.org
