ADVERTISEMENT
Behavioral Health Parity Protections Should Be Extended to Additional Domains
Earlier this year, President Joe Biden announced and then incorporated a major behavioral healthcare initiative into the administration’s fiscal year 2023 federal budget request. Over the past 5 months, I have presented an overview of his plan, followed by summaries of its 3 principal components:
- Growing the behavioral healthcare workforce
- Extending parity protections to all health insurance
- Expanding behavioral healthcare services into new community settings
I also developed analyses that amplify and add further specificity to the president’s workforce proposal and his service extension proposal. Finally, I compared each of the 3 components to several core values of the behavioral healthcare field. The results suggest that the president’s initiative aligns closely with our core values.
Here, I would like to explore and extend Biden proposal to implement behavioral health parity in all health insurance programs, including Medicare and Medicaid.
The road to implementation of behavioral healthcare parity in health insurance has been a rocky one for almost 15 years. Key public insurance programs have been excluded—specifically, Medicare and major parts of Medicaid. Some private insurance plans have been “grandfathered” into earlier benefits that do not meet parity requirements, and some plans have been excluded because they do not offer any behavioral healthcare benefits. State health insurance commissioners have been slow to adopt and require parity, and enforcement mechanisms administered by the Department of Labor have been either deficient or nonexistent.
The net effect is that parity implementation remains quite incomplete. My own analysis suggests that 47% of adults still lack parity protections. Thus, the president proposes extending parity to all health insurance programs, requiring that all plans offer 3 behavioral health visits per year without any copay, and enhancing enforcement mechanisms.
Much of the debate and discussion about parity has centered upon quantitative and nonquantitative treatment limitations: specifically, quantitative (e.g., equivalency of behavioral healthcare visit limits with those for primary care) and nonquantitative (e.g., equivalency of managed care limits). Clearly, the focus has been upon access to care. Now, we need to ask whether the implementation of parity also should extend to other domains of care.
The first of these domains is care quality: Care quality should be equivalent between behavioral healthcare and primary care services. Clearly, a primary prerequisite of equivalent care quality is the adequacy of the service networks for behavioral health and primary care. Are they adequate and are they equivalent?
Much already has been written about the inadequacy of the care networks for behavioral healthcare services, particularly in rural communities. As evidence, recent commentary has focused on the “phantom doctors” who are listed but not actually present in a number of these behavioral healthcare networks.
The second domain is care outcome: Care outcome should be equivalent between behavioral healthcare and primary care services. Here, a number of factors are involved for behavioral health: provider training, including technical skills, cultural competence, recovery orientation, and person-centeredness; deployment of evidence-based care; goal setting with the service user; and actual measurement of consumer-oriented outcomes.
Today, we still have much to do to achieve equivalent care outcomes between behavioral healthcare and primary care. However, we also can be optimistic that progress is being made. We have adopted a person-centered care philosophy. And the movement toward integrated care has gained considerable strength in the past several years. These changes will assure more attention to equivalent outcomes between the 2 fields going forward.
We are quite delighted that President Biden has included universal parity of access in the plan that he has proposed to Congress. This is an essential first step toward insuring parity of care. We do hope that Congress also will consider parity of care quality and care outcome in its deliberations. Our strong advocacy will be required to bring this about.
Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
Reference
