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December 18, 2007
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Christopher Fleming

Parity Legislation Could Actually Reduce Access ToMental Health Treatment If Out-Of-Network Benefits Are Not Guaranteed, Researchers Warn

Study Finds That Most Clinicians In National Capital Area Do Not Participate In Plan Networks

Bethesda, MD -- Congress is on the verge of passing legislation mandating that health plans cover mental health (MH) and substance abuse treatment to the same extent that they cover other medical and surgical treatment. In a study published today on the Health Affairs Web site, researchers say that passage of either the Senate or House version of this legislation would constitute a major improvement over the current 1996 Mental Health Parity Act, which only guaranteed equal annual and lifetime payment limits. However, the authors also warn that parity legislation could actually reduce access to MH treatment for some patients if it does not facilitate treatment by providers outside insurers’ networks. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.1.w70

The study finds that, in 2005, only a minority of mental health providers in the national capital area participated in networks affiliated with the Federal Employees Health Benefit (FEHB) program, Medicare, Medicaid, or private insurance coverage. Only 38 to 49 percent of the area’s psychiatrists, psychologists, and social workers were members of any network. Participation in FEHB networks was limited to approximately one-third of clinicians, and only 44 percent of FEHB patients received MH care from network clinicians.

“Our study shows that even in an area relatively rich in mental health resources such as Washington, D.C., and its surroundings, plan networks are not equipped to meet the full need for mental health treatment,” said lead author Darrel Regier, executive director of the American Psychiatric Institute for Research and Education (APIRE). “Maintaining the out-of-network option is essential to ensuring access to treatment.”

The version of parity legislation passed by the Senate would allow plans to vary the types of mental disorders covered under parity and to drop out-of-network MH coverage altogether if they decide that offering such benefits is not in their best interest. In contrast, the parity bill moving through the House would require plans to cover all mental disorders and to cover out-of-network MH treatment at the same levels as other out-of-network treatment.

“If the Senate approach prevails and plans do eliminate out-of-network mental health benefits, patients could find that they have a guarantee of parity in mental health coverage but an inadequate number of clinicians available to actually provide the treatment they need,” said Regier. “Also, allowing plans to vary the level of coverage for different disorders could result in adverse selection for plans that offer better mental health benefits, prompting the sort of race to restrict coverage that occurred when OPM [the Office of Personnel Management] allowed FEHB insurance companies to vary their coverage levels in 1982. Providing a level playing field where benefits are a constant for all insurance plans promotes competition on the basis of service quality rather than incentivizing plans to maximize profits by attracting beneficiaries with lower service needs.”

For Network Clinicians, Inadequate Reimbursement
Was The Biggest Barrier To Accepting New Patients

Regier and his coauthors from APIRE, the American Psychological Association, and the National Association of Social Workers found that the majority of participating network clinicians in the national capital area were accepting new patients in 2005, and indeed the majority of network providers had immediate openings for new patients. However, given that most clinicians did not participate in networks at all, only a minority of area clinicians overall both were in-network and offered immediate openings.

For example, only about 14 percent of psychiatrists, 18 percent of social workers, and 20 percent of psychologists in the national capital area were participating in an FEHB network and had immediate openings for new patients. Among clinicians in FEHB networks, the most common reason for not accepting new patients was that plans’ fees were too low; participating clinicians also cited the extensive administrative work and telephone time associated with in-network patients as a reason for not accepting new patients.

“Expanding network capacity in the national capital area and elsewhere would require major efforts to increase reimbursement and reduce the administrative burden associated with network participation,” Regier said. “These changes do not happen overnight, so it is crucial to maintain an out-of-network option for those in need of mental health treatment.”



Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.


©2007 Project HOPE–The People-to-People Health Foundation, Inc.