On November 8, 2013, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced the promulgation of the agency’s final rule related to parity of coverage of mental health and substance use treatment. According to Sebelius: “For way too long, the healthcare system has openly discriminated against Americans with behavioral health problems.”
The purpose of the regulations is to close the gaps in coverage that permit insurance carriers to treat mental and substance-abuse related treatment different from traditional medical and surgical benefits.
Among the key provisions of the regulations are the elimination of separate mental health deductibles, co-insurance, etc.; elimination of limits on lifetime benefits; as well as several other measures insuring that mental health benefits are treated on par with traditional medical and surgical benefits.
Compliance with the final rule will be required by group health plans and health insurance issuers offering group health insurance coverage on the first day of the first plan year beginning on or after July 1, 2014.
Effects on Healthcare Providers.
From a business perspective, this final rule may change the type of coverage that is required to be offered by a practice to its employees. Likewise, employed practitioners may see changes in the way the coverage offered by their employers works.
Also, these rules may allow primary care providers to significantly limit their exposure to civil and administrative complaints resulting from the provision of basic mental health services. Often times patients who are unable to afford mental health coverage rely on their primary care physician for assistance. This sometimes leads to primary care doctors prescribing and managing medication for which they are inadequately trained or otherwise uncomfortable with.
By ensuring parity in coverage, primary care physicians should be able to make referrals to mental health providers with confidence that their patients will not face any artificial barriers to coverage.
Additionally, mental health providers will likely see an increase in patient volume and utilization. These increases will likely come from additional referrals from physicians as well as increased self-referrals from patients seeking to take advantage of their coverage.
Finally, with increased utilization comes increased revenue, and with increased revenue comes increased scrutiny. Private insurers have undertaken an auditing protocol that is remarkably similar to that of federal payors like Medicare, Medicaid, TRICARE, etc.
Considering the abuses that have been publicized in the mental health sector and the increased scrutiny coming from federal and state governments, we expect mental health providers will receive the same or similar audit treatment from private payors.
Be Prepared for Possible Change in Mental Healthcare Field.
Should the Affordable Care Act (ACA) ultimately serve to dramatically increase the number of Americans with insurance coverage, mental health providers may find themselves at the forefront of a rapidly expanding part of the healthcare field.
Be prepared for these changes by reviewing your processes and documentation. Consult with an experienced healthcare attorney or other similarly qualified expert to make sure your practice is ready.
The Health Law Firm Supports the Mental Health Parity Rule.
The Health Law Firm fully supports the Mental Health Parity Rule. The provision of mental health services for our citizens is long overdue.
Many fail to recognize the costs paid by our society to deal with those who have mental health issues outside of the healthcare system. Jails and prisons are often the final repository for those who should receive hospital treatment. Many individuals who are homeless, who are veterans, or who have serious mental health issues could lead constructive, productive lives if they receive proper mental health treatment.
Psychologists, psychiatrists, mental health counselors and social workers should be happy for the adoption of the regulation. In addition, law enforcement officials, judges and relatives of those with mental illness must also be thankful.
Contact Health Law Attorneys Experienced in the Representation of Mental Health Counselors, Psychologists, Social Workers, and Marital and Family Therapists.
The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, psychiatrists, social workers and family therapists in Department of Health (DOH) investigations, business transactions, contracts, structuring business ventures, clinical privileges actions, professional licensure matters, Board hearings, business litigation, Medicare and Medicaid audits, and other types of investigations of health professionals and providers.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Were you familiar with the final mental health and substance use disorder parity rule? How do you think it will affect the mental healthcare field? Please leave any thoughtful comments below.
U.S. Department of Health and Human Services Press Office. “Administration Issues Final Mental Health and Substance Use Disorder Parity Rule.” U.S. Department of Health and Humans Services. (November 8, 2013). From: http://www.hhs.gov/news/press/2013pres/11/20131108b.html
About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.
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