Here is a look at key issues that await resolution in final mental health parity regulations:
Scope of Services. It is far from clear which mental health and substance abuse services must be covered by an employer who offers these benefits. In interim rules for the federal parity act issued in
January 2010 the government outlined six categories of services: inpatient care and outpatient care (both in and out of network); emergency care; and
prescription drugs. If services in any given category are covered on the medical/surgical side of the equation they have to be covered on the mental
health/substance abuse side as well, it said.
However, this didn't clarify whether a full continuum of services is required or whether only a few services in each category are enough.
Insurers and employers claim that the federal statute did not address the issue intentionally. "We believe Congress did not intend the parity requirements
to govern the types of services or settings of care that may be covered," America's Health Insurance Plans wrote in May 2010 comments on the interim rule.
"If rules get more prescriptive and [mental health/substance abuse] benefits potentially get more expensive, that could lead an employer to drop benefits
altogether, and we don't want to see that happen," said Pamela Greenberg, president of the Association for Behavioral Health and Wellness, which represents companies that manage mental health and substance abuse
But advocates point to problems. Without more guidance on "scope of services," an insurer could "pick and choose services" it wanted to cover, leaving
important categories of care excluded, said Dr. Henry Harbin, a psychiatrist consulting with the Parity Implementation Coalition, a group of provider and
Currently, a significant number of insurers don't cover residential services, partial hospitalization, or intensive outpatient care for people with mental
illnesses or substance abuse disorders, even though this type of care is often deemed necessary by mental health providers.
Danielle Moles, who lives in LaGrange, Illinois, has experienced the problem first hand. Moles, 32 years old and a nurse, has anorexia and exercise-induced
bulimia, complicated by major depression. She's been hospitalized repeatedly and denied residential treatment and intensive outpatient care several times
by her insurance company, which provided coverage for the large hospital where she worked.
Mole admits to being suicidal at times. Unable to get the help she needs, she said, "I will sit there and cry so hard I can't catch my breath. This is the
worst kind of torture, and I don't want the next person to go through it."
Medical management. Controversy erupted when the government's interim rules indicated that the parity law also applied to medical management strategies that insurers use to
decide whether services are necessary and assemble provider networks, without spelling out in detail how this should be accomplished.