[NYAPRS Enews] MHW: N.Y. Parity Law Study Prompts Calls For Federal Law Education

Mon Apr 4 07:47:41 EDT 2011

N.Y. Parity Law Study Prompts Calls For Federal Law Education

Mental Health Weekly  April 4, 2011

A recent study of employees' knowledge of and access to mental health
benefits following implementation of New York State's parity law in
2007, found that many were uninformed about the change in mental health
care benefits, prompting a call from field experts for more education
about state and federal parity laws.

Study authors say that consumers of the state parity law cited a lack of
knowledge and inadequate communication from their health plan as
barriers to accessing benefits. Although the consumers are responding to
New York State's parity law, the authors using those responses as a
barometer, say that educating consumers about the federal parity law is
required to ensure that the 113 million Americans affected by the
federal parity law, the

Pete Domenici and Paul Wellstone Mental Health Parity and Addiction
Equity Act (MHPAEA), are alerted to their extended benefits and able to
access them.

The study, "Parity from the Consumer Perspective: Implications for
Federal Implementation from New York's Parity Evaluation," reported in a
column in the April issue of Psychiatric Services, by Vera Oziransky,
M.P.H., the director of research and advocacy at the National Alliance
on Mental Illness of New York City (NAMI-NY Metro), and colleagues found
that most of the employees interviewed had been informed of their
insurance coverage benefits before the state parity law, known as
"Timothy's Law," but were not aware of the extended coverage as a result
of the law.

Timothy's Law mandates that all companies that issue health insurance
regardless of size in New York State have to cover a base benefit of 20
outpatient mental health visits and 30 inpatient hospital stays for all
members. It also requires parity between cost-sharing requirements for
mental health coverage and medical-surgical coverage.

The state law does not cover substance abuse services. The state law
extends full mental health parity coverage for a number of biologically
based diagnoses and childhood emotional disorders by mandating equality
between the treatment limitations imposed on coverage of these
conditions and

medical-surgical coverage.

Study details

Researchers at NAMI-NYC Metro conducted telephone interviews with 54
employed individuals with private insurance by phone, including 32
adults with mental illness and 22 parents of children with mental
illness.

All employees had health insurance coverage issued in New York State
from a fully insured company. The study found that 17 of the 37
interviewees were entitled to full parity coverage were aware of the
parity extension of their outpatient benefits of the 20 who were
unaware, 12 reported the preparity limit on their benefits, seven did
not know their benefits coverage and one response was missing.

According to the study, four of the 10 participants who were eligible
for full parity coverage and reported having used inpatient services
were aware of the extension of their inpatient benefits, four reported
the preparity limit on coverage, and two did not know their coverage.
Few employees

had accurate knowledge of the law's parity provision.

The study noted that awareness of health services has been found to have
a strong influence on service utilization. The investigators found that
the majority of participants were unfamiliar with the New York law and
expressed a need for education about parity.

The study findings also indicate an "urgent need" for benefits education
and monitoring of health plan communications on a federal level,
researchers wrote.

NAMI researchers identified recurrent themes about the New York parity
law among the responses, including:

* Difficulty getting information on mental health benefits compared to
general medical/surgical benefits.

* Difficulty in finding a high quality mental health care provider in
the health plan network.

* Unclear or incomplete information in health plans' written and verbal
communication.

* Problems with health plan provider lists, e.g., including providers no
longer accepting the insurance and long waits for appointments.

Parity education

"The next step is for all of us in the field to be educated and to make
sure hospitals, private providers, and licensing agencies understand the
federal parity law and how it operates," Barry B. Perelman, M.D.,
director of the Department of Psychiatry at St. Joseph's Medical Center
in Yonkers, N.Y., told MHW.

Perelman added, "Everyone has to be aware of the federal parity law and
assert their right under the law in order to realize the effects of the
law."

The federal parity law gives providers a "tool" to push back against the
policies and approaches that "created inappropriate discrimination
against people receiving services and receiving the services that their
conditions warranted," said Perelman, who did not author the New York
State study.

The study authors suggest that at the federal level, it is imperative to
develop standards for comprehensive written and verbal communications

from health plans about mental health benefits and to monitor those
communications for compliance with the standards.

At the community level, mental health providers and advocates must
educate clients and community members on their websites or in
newsletters, they wrote. Human resources professionals should develop
programs to educate all employees regarding extended parity benefits
while simultaneously addressing workplace stigma.

"It's going to take a lot of hard work for us to achieve what the what
the law promises," said Perelman. *

For more information or concerns about the federal parity law, visit

www.mentalhealthparitywatch.org/pages/mentalhealthparity.aspx.

-------------------

A Law You Need To Know About

By Wendy Brennan  Albany Times Union Op Ed  April 4, 2011

Four years ago, New Yorkers with group health insurance coverage were
guaranteed access to improved mental health benefits under Timothy's
Law, the state's mental health parity law.

If you didn't know that, you're not alone.

The first qualitative study of the law, published in the journal 
Psychiatric Services
<http://www.timesunion.com/?controllerName=search&action=search&channel=
opinion&search=1&inlineLink=1&query=%22Psychiatric+Services%22>  and
conducted by the National Alliance on Mental Illness
<http://www.timesunion.com/?controllerName=search&action=search&channel=
opinion&search=1&inlineLink=1&query=%22National+Alliance+on+Mental+Illne
ss%22>  of New York City, finds that employees covered by it are largely
unaware of their benefits and are continuing to encounter significant
barriers as they attempt to access high-quality services.

State and federal parity laws help end decades of discriminatory
insurance coverage for mental health and substance abuse services by
insurance companies. Previously, families with mental illness faced
bleak options, including forgoing care, facing bankruptcy to pay for it
or -- in the case of the family for whom the law is named -- turning
over custody of an ill child to secure treatment after exhausting
limited benefits.

While benefits under Timothy's Law depend on an employer's size, key
provisions include a minimum mental health benefit and parity between
cost-sharing requirements for mental health and medical-surgical
coverage. A similar federal law, which took effect in January 2010,
mandates mental health parity for companies with more than 50 employees.

Unfortunately, health plans do not appear to be providing clear
communication or complete information about extended mental health
benefits to employees. Written notices lack descriptions of full
benefits, online information is hard to find, and in some cases, health
plan representatives are unfamiliar with the law.

Difficulty locating high-quality, in-network providers is a major
obstacle for employees seeking mental health care. Furthermore, provider
lists often contain those no longer accepting members' insurance or with
waiting times for appointments of weeks, even months.

Beyond scarce information and provider options, the aggressive
mechanisms used to regulate mental health benefits are another common
complaint.

In some cases, preauthorization requirements for mental health services
are not comparable to those for general medical care. Criteria for
determining the medical necessity of inpatient care are elusive. Worse
yet, denials of care on the grounds of medical necessity have been
reported to be inconsistent with the assessments of providers.

Education efforts by health plans can ensure that Americans affected by
parity laws are alerted to their extended benefits and able to access
them. Federal standards would help, as would monitoring of these
communications, which must be clear and accessible to any person seeking
care.

Mental health providers must educate clients about their extended
benefits. Behavioral health agencies can assist this effort by making
benefits information available online and in newsletters.

Human resources departments should develop education programs for their
employees. This is, after all, employer-based insurance, and untreated
mental illness in the workplace impacts the bottom line. These efforts
would simultaneously address stigma, the most persistent barrier to
care.

The provision of the federal law that mandates parity in inclusion
criteria for provider networks needs to be monitored. Individuals
seeking mental health services must be able to find providers nearby
that accept their insurance and have appointments available in a
reasonable period of time.

New York created the potential for enhanced access to mental health care
by extending benefits for families with mental illness through Timothy's
Law. With leadership from health plans and employers -- and effective
oversight by the government -- this possibility can be a reality.

Wendy Brennan is the executive director of the National Alliance on
Mental Illness of New York City (NAMI-NYC Metro).

http://www.timesunion.com/default/article/A-law-you-need-to-know-about-1
321081.php#ixzz1IYIkQLY2

------------------

Dear Friends, 

We are pleased to announce that NAMI-NYC Metro has published the results
of its qualitative study of Timothy's Law, New York State's mental
health parity law, in the April issue of Psychiatric Services, a journal
of the American Psychiatric Association.

Below is today's press release announcing the publication; you can
access the study online here
<http://ps.psychiatryonline.org/cgi/content/full/62/4/344> .

In this, the first full year that federal parity law has begun to cover
millions of Americans, we hope that our findings from New York - which
include a clear need for comprehensive education efforts and monitoring
of provider networks - will contribute to our shared goal of creating
educated consumers who are better able to access the care and treatment
they need.

This multi-year effort was made possible with support from our academic,
business community, government, grant-making and mental health partners.
We are grateful to you all.

All the best, 

Wendy Brennan

--------------------

For Information Contact:                                           `

Eve Herold, 703-907-8640

press at psych.org

Erin Connors, 703-907-8562
Justin Burke, 212-684-3365

econnors at psych.org
jburke at naminyc.org

Study of New York Parity Law Provides Lessons for Implementation of
Federal Law

Consumers Indicate Need for Improved Communication from Health Plans

ARLINGTON, Va. (April 1, 2011) - A study of consumer experiences after
implementation of the New York State mental health parity law in 2007
found many consumers uninformed about the change in mental health care
benefits.  Barriers to access to mental health benefits and high-quality
services identified in a qualitative study of consumers' experience in
New York may provide lessons for implementation of the federal mental
health parity legislation, passed in 2008. 

The study, reported in a column in the April issue of Psychiatric
Services, a journal of the American Psychiatric Association, found that
few employees had accurate knowledge of the state's parity law
provisions. Most had been informed of their insurance coverage benefits
before the state parity law in 2007 but were not aware of the extended
coverage as a result of the law.

Researchers at the National Alliance on Mental Illness of New York City
(NAMI-NYC Metro) conducted telephone interviews with 54 employed
individuals with private insurance coverage by phone, including 32
adults with mental illness and 22 parents of children with mental
illness. Researchers identified recurrent themes among the responses,
including:

*	Unclear or incomplete information in health plans' written and
verbal communication;
*	Difficulty getting information on mental health benefits
compared to general medical/surgical benefits;
*	Difficulty finding a high-quality mental health care provider in
health plan network;
*	More aggressive management of mental health care benefits than
medical-surgical benefits; and
*	Problems with health plan provider lists, e.g., including
providers no longer accepting the insurance and long waits for
appointments.

"After a decade-long fight to end the discriminatory design and
administration of mental health benefits, our study underscores the need
for comprehensive education programs and effective oversight to ensure
access to quality mental health treatment," said Wendy Brennan,
executive director of NAMI-NYC Metro.

Forty-nine states have passed mental health care parity legislation. The
state laws vary in the size of companies covered, the range of diagnosis
covered, and the mandated level of mental health coverage.  The New York
law, effective in 2007, requires all companies that issue health
insurance to provide a minimum mental health benefit to all members and
requires that cost-sharing requirements for mental health benefits be
the same as general medical-surgical coverage. 

Findings "indicate an urgent need for benefits education and monitoring
of health plan communications on a federal level," according to the
study authors. The authors also pointed to the broader issue of the
shortage of mental health providers, especially for children, as an area
of concern nationally.

The study was led by Vera Oziransky, M.P.H., former director of research
and advocacy at NAMI-NYC Metro.

The American Psychiatric Association is a national medical specialty
society whose physician members specialize in the diagnosis, treatment,
prevention, and research of mental illnesses including substance use
disorders.  Visit the APA at www.psych.org <http://www.psych.org/>  and 
www.HealthyMinds.org <http://www.healthyminds.org/> . 

The National Alliance on Mental Illness of New York City Metro is a
grassroots organization that provides support, education and advocacy
for families and individuals of all ethnic and socio-economic
backgrounds who live with mental illness. For more information, visit 
www.naminycmetro.org <http://www.naminycmetro.org/> . 

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