Calif. Managed Care Plans Struggle To Achieve Mental Health Parity
Although California has been one of the most "proactive" states in attempting to ensure timely access to mental health care, the state still has struggled to enforce compliance of the federal mental health parity law, Kaiser Health News reports (Gold, Kaiser Health News, 8/13).
Under the 2008 federal mental health parity law, coverage for mental health must be equal to that for other medical conditions. As a result of the law, insurers have dropped annual limits on therapy and reduced copayments and deductibles for mental health. However, insurers still can deny coverage by deciding what treatments qualify as medically necessary (Gold, Kaiser Health News, 8/3).
In 2014, the federal government mandated that insurers could not use higher copayments or limit the number of mental health treatments as a way to address behavioral health differently from primary care (California Healthline, 8/3).
Parity Problems in California
According to KHN, California has done a number of things to ensure mental health parity. For example, in addition to the 2008 federal measure, a separate California law requires insurers to provide patients with mental health care access within a designated timeframe. Further, the California Department of Managed Health Care last year implemented a mandate that insurers under its supervision prove their compliance with the federal mental health parity law.
Despite those efforts, parity is still difficult to achieve, according to KHN.
For example, none of the 26 managed care insurers reviewed by DMHC last year were able to demonstrate full compliance. Most documents were filed incompletely or incorrectly, KHN reports. DMHC also found cases of insurers trying to control costs through discriminatory measures, such as limiting the number of days a patient could receive inpatient mental health care.
DMHC Director Shelley Rouillard said the managed care plans under DMHC supervision currently are in in different stages of achieving compliance, with only one plan so far in 2015 successfully demonstrating full compliance. However, both she and California Association of Health Plans President and CEO Charles Bacchi said they expected other plans will achieve proof of compliance by the end of the year.
In 2016, the department plans to implement a more intensive review (Kaiser Health News, 8/13).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.