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.
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2 comments:
I agree with David that the private sector insurances should pay for the services that will offered under CBHI. I have been empowering some parents to be more vocal in contacting their legislators to find out what needs to be done about this matter.
It is very unfair that some private insurances won't pay for intermediate services and that clinicians have to beg for more sessions for those children who have serious emotional needs.
In my testimony to the Mental Health and Substance Abuse Committee, I ended my summary by stating that "A child is a child no matter what socioeconomic class they belong to. Their mental health needs to be covered across the board if their diagnosis is serious emotional disturbance.
Robbin Miller
Private Practitioner/Citizen-Advocate
Facilitator for www.therapistsforchange.blogspot.com.
Yes!
We were found eligible for mass health, but the cost for it, as secondary insurance for one child, was $561 a month. Even as we are "rich" by mass health standards, we can't afford to pay an extra $561 per month for a secondary insurance that no one actually accepts, in hopes of what may be an illusory set of services to be delivered sometime in the misty future, particularly since we're spending over $1000 per month to go through due process to protect our son from near-constant restraint and seclusion at school. So we don't have mass health anymore. Sigh.
So I've got my employer-sponsored health plan, HPHC, who has told me they refuse to pay for any in-home treatment of any kind. After hours on the phone I got a care advocate. We've never actually spoken directly, but after trading phone messages, she told me no in-home services, and also she knew of no ABA providers anywhere near me. Never heard of the May Institute.
My son has asperger's and mental illness with aggression. He's at serious risk for residential/hospitalization. We have strong cultural capital and advocacy skills. And the only really practical advice we've gotten on in-home care (from a profsesional) is Craigslist. I'm not kidding.
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