Thursday, June 4, 2009

What about the Mental Health in Private Sector?

One of the things that I have been learning about public policy over the past 2 years (the duration of my almost concluded Physician Advocacy Fellowship) is that the passage of a law or the implementation of a regulation is but the first step along the road to change.  The other is that there are many things in the air at once, and it is important to pay attention to all of them.  Lately, I have been focused on the upcoming CSA deployment in the CBHI, the implementation of Yolanda's Law and the passage of legislation focusing on reimbursement for collateral contacts.  But aren't we also in the midst of rolling out the Mental Health Parity Laws, both State and Federal?  Turns out we are, and the Children's Mental Health Campaign has been right on top of that, even if I haven't been watch that aspect of this complex dance as well as I might have done.

While we have been working on the Medicaid system, and on finishing off the Omnibus Mental Health Bill, the Department of Mental Health has been trying to clarify what the new Mental Health Parity Laws mean in real life.  They issued one memorandum to the commercial insurers in March,  in which they clarified who was covered;  they need to issue a memorandum discussing what sort of services should be covered under the parity law.

The big sticking point  is the level of intermediate services that are covered.  Both Medicaid and the Private payers cover the easy stuff:  When I want once a week meetings with a therapist for a child with mild mental illness, I can get that through the outpatient department.  When I want hospitalization, I can get it if I jump through enough medical necessity hoops.  What about all of the other services that we can get for children on Medicaid (but not on the privates), like the ICC, the Home-based behavioral and psychotherapy sessions, the Parent Partners and the like?  I once had an insurance company (or rather a nice person at an insurance company)  tell me that they would rather pay for the EMH and Hospitalization than cover in-home therapy for a kid who was making weekly trips to the psych ER.  Wouldn't budge, even though it would save them money.  So, doesn't it make sense that Mental Health Parity means that the private sector should cover the same services as are covered by Massachusetts Medicaid program?

That is the message that we in the  Children's Mental Health Campaign want to send to the Division of Insurance and the Department of Mental Health:  parity means more that covering hospitalization.  Private insurance should cover a WIDE RANGE of Intermediate Services, including :
  • Intensive Care Coordination
  • Community Based Acute Treatment
  • Family Consultation
  • Day Treatment
  • Crisis Stabilization
  • Family Stabilization
and many other things.  Basically, private insurance should cover everything that the public sector is providing under the CBHI.  Intermediate Care is the key to creating a mental health system that actually achieve parity with the physical health system.

FEEDJIT Live Traffic Map