WASHINGTON (FRONTLINE MEDICAL NEWS) – Just because mental health parity laws exist, doesn’t mean they are enforced.
Speakers at this year’s second annual State of the Union in Mental Health & Addiction, cosponsored by the Kennedy Forum, the Satcher Health Leadership Institute, and the Morehouse School of Medicine, Atlanta, singled out insurers, employers, politicians, and philanthropists as not doing enough to ensure the same access to mental and behavioral health care as exists for physical care. The Mental Health Parity and Addiction Equity Act was passed in 2008.
Former congressman Patrick J. Kennedy, who spoke at the event, said it is time “to frame this issue as one of medical civil rights, because the [health care] system we all have all grown up with is one of separate but unequal care.” Likening it to pre–civil rights era separate drinking fountains for black and white Americans, Mr. Kennedy said, “We need to eliminate the notion we need to send people all the way down the hall to drink from the colored water fountain of a mental health system that is ill-equipped, ill-reimbursed, and relegated to the margins of our health care system.”
Former U.S. Surgeon General David Satcher also spoke at the event , describing how as a young protester jailed in the 1960s for participating in Rev. Martin Luther King Jr.’s organized acts of civil disobedience, he learned that “leadership is a team sport.” Dr. Satcher said he is now dedicated to working with others to bring about equal rights for those with brain illnesses.
“Mental health parity is another step forward in the struggle to advance the civil rights of those with mental health and substance use disorders,” Dr. Satcher said.
Dr. Satcher and other panelists agreed on five key elements essential to creating a health care system that will bring physical and mental health into alignment:
• Substance use and mental health screening performed at the time of the annual physical check-up.
• “Brain fitness” programs, such as mindfulness meditation and other emotional resilience training, in schools and workplaces.
• Smartphone technologies that can deliver remote mental and behavioral health care for those who are not always able to access it in person.
• Coordinated team-based mental and physical health care services delivered in the primary care setting, in place of siloed specialty care.
• Implementation of policies and procedures for mental health care services on par with those for oncology, cardiology, diabetes, and other serious or chronic conditions.
According to Mr. Kennedy, because employers are not well-informed enough about what health benefits meet the legal standards, third-party administrators don’t always stretch themselves to provide adequate in-network care for mental health services.
“We need the self-insured companies to pressure [their third-party benefits administrators] to do what they ought to be doing and actually insure adequate access to care,” Mr. Kennedy said. He called for an end to insurers creating “phantom networks” that ostensibly provide adequate coverage under stated policy premiums, while in practice, forcing people to “pay extra, huge copays and deductibles for the mental health services” not actually included in their plans.
Mr. Kennedy also said political parties should expect a large mental health advocacy presence this year at both parties’ conventions, and in an interview noted that he and Dr. Satcher intended to help create an advocacy movement so strong that it will supersede whichever political party wins in November.
“It might be a medical issue, but it takes political will for things to change,” Mr. Kennedy said in the interview.During the question and answer portion of the event, Dr. Patrick Conway , deputy administrator for innovation and quality, and chief medical officer at the Centers for Medicare & Medicaid Services, did not demur when panel moderator Linda Rosenberg, president and CEO of the National Council for Behavioral Health , referred to him as leading an “amazingly activist CMS.”
Dr. Conway agreed, saying, “We are trying to be a catalyst for change. We’re trying to [promote] that culture at CMS.”
He emphasized how CMS is focused on measurement-based mental health care, including symptom-rating scales such as the PHQ-9 (Patient Health Questionnaire 9, a measure of depressive symptoms), which is a required metric in Medicaid-funded accountable care organizations.
Dr. Conway also pointed to CMS spending more than $650 million this year to help physicians integrate mental and physical health care in their practices. Additional funds are being spent, he said, on so-called accountable health communities that address the social determinants of health, such as homelessness. “We know that integrating mental and behavioral health will be critical to the success of these communities,” Dr. Conway said, adding that Medicare providers can expect to see a rollout of a collaborative care model in January 2017 that will include integrated mental, behavioral, and physical health.
“Our fundamental issue is the ‘scale and spread’ question,” Dr. Conway said, speaking about all CMS-funded programs.
Behavioral health facilities and some primary care facilities seeking accreditation from the Joint Commission also were put on notice by Margaret VanAmringe , the commission’s executive vice president of public policy and government relations. Ms. VanAmringe told the audience that, as of this year, the commission is adding a measurement-based requirement for behavioral health facility accreditation using a patient-tracer method that will collect data on what kind of interaction occurred between a patient and every provider at the facility. The commission will be taking public comment on the change, but Ms. VanAmringe said the decision to include the requirement already had been made.
“We want to get it in place by CMS’s [new collaborative] reimbursements in 2017,” she said.
Philanthropists also were called out for not doing their part to improve parity. “Philanthropists, get in the game! They’re absent,” Mr. Kennedy said. “It’s an outrage that grant makers in health [care] … fail to [insist] that everything they fund has a mental health dimension. What a revolution [it would be] … if philanthropy had a gold standard for best practices in funding parity.”
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