Parity: Now an “Essential” Health Benefit
By Katrina Gay, NAMI Director of Communications, and Angela Kimball, NAMI Director of State Policy
People living with mental health conditions and their families are preparing for major changes in health care benefits. The long-awaited U.S. Department of Health and Human Services (HHS) proposed essential health benefits (EHB) rule guiding coverage in individual, small-group and health insurance exchange plans was published on Monday, Nov. 26, 2012 in the Federal Register. Public comments will be accepted for the next 30 days.
This is of vital importance for many reasons, and NAMI is poised to help individuals both prepare for these changes and gear up as self-advocates. These rules will impact all exchange plans, which begin on Jan. 1, 2014, and other health insurance plans as they are renewed throughout the year.
When the new health care law was passed, it included something called EHBs. EHBs are a set of 10 categories of services that must be offered in individual and small-group health insurance plans, or private insurance plans. For the first time ever, it will required that mental health and substance abuse treatment include all individual and small group plans at parity, or equal to the cover given to other health conditions.
There are 10 categories of EHBs included in these new rules: (1) ambulatory patient services, or outpatient health care, (2) emergency services, (3) hospitalization, (4) maternity and newborn care, (5) mental health and substance abuse services, (6) prescription drugs, (7) rehabilitative and habilitative services and devices, (8) laboratory services, (9) preventative and wellness services and chronic disease management and (10) pediatric services.
Although all of these are important, three of these categories offer a huge benefit to individuals with mental illness and their families.
The first of these is mental health and substance abuse services. Although the U.S. has had federal parity for some time, it has specifically excluded individual and small-group plans. Now, for the first time, these plans will have to include this “parity,” that is to say, they will have to provide benefits for these services equal to the benefits they offer all other health conditions. Although many states had mental health parity laws of various sorts, many had exclusions that narrowed the law’s reach. The expanded coverage of mental health and substance abuse services is a huge improvement for states with limited parity laws and definitely a boon for individuals living in states that did not have provisions for parity at all.
The second EHB of significance is the prescription drug category. Prescription drug coverage must be included in any individual or small group plan. People with mental health conditions reliant on medications can’t be denied this benefit, which is of critical importance especially to those who do not currently have this benefit in their existing coverage or who will now be able to have this benefit through one of the emergent health insurance exchanges.
And finally, rehabilitative services will be supported by insurance plans to individuals in small group and individual plans. These services have traditionally not been present in private plans in the past and may include psychosocial rehabilitation, personal care services, job coaching, activities of daily living and others. This could represent a significant shift in how these types of mental health services and their availability are delivered and covered through private health insurance. For the first time in some states, an individual will not need to be enrolled in Medicaid in order to receive essential rehabilitative services that many people recovering from mental illness find essential.
Now that the rules have been passed, NAMI will be working in 2013 on shaping how this gets implemented by writing comments, educating the public and inspiring policy. In this way, NAMI can continue to better shape the future of mental health care so that people with mental illness and their families can have more opportunities for recovery.
For those interested in learning more about EHBs and roles for grassroots advocates, NAMI will be hosting a webinar on this topic on Friday, Dec. 14, 2012 at 12 p.m. ET. Registration is required.