Behavioral Health Care in Reform Legislation

The 111th Congress has been considering various proposals that aim to improve the quality of and access to health care, including aspects of behavioral health care such as treatment for mental illnesses and substance abuse disorders. Behavioral health care-related proposals include

requiring behavioral health coverage, expanding the provider workforce, improving behavioral health care coordination, and increasing funding for research on mental illness. Specifically, the proposals include provisions that would expand the scope of behavioral health parity, authorize grants to train behavioral health care providers, and provide for research on postpartum depression. Of these provisions, the one with possibly the most far-reaching effect would be that of expanding the scope of behavioral health parity.

In 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), signed into law on October 3, 2008 (P.L. 110-343). This law expanded previous federal requirements for behavioral health coverage (which required parity for behavioral health coverage with that for physical illnesses in terms of annual and lifetime treatment benefits). Generally, the provisions of MHPAEA apply at the beginning of the plan year beginning after October 3, 2009. In April 2009, the Departments of Treasury, Labor, and Health and Human Services sought feedback from insurers and behavioral health providers about the costs and benefits of MHPAEA, impact on small employers, additional paperwork burdens, and regulatory concerns with regard to MHPAEA’s various provisions. The departments expect to publish final regulations for the implementation of MHPAEA by January 1, 2010. Under H.R. 3962 (Affordable Health Care for America Act), which passed the House on

November 7, 2009, qualified health benefits plans (which would be required to provide behavioral health services) would be required to comply with the MHPAEA rules regarding the amount, duration, and scope of mental health and substance abuse benefits. This is also true of the minimum qualifying coverage specified in the Senate amendment (S.Amdt. 2786) in the nature of a substitute to H.R. 3590 (Patient Protection and Affordable Care Act). MHPAEA would also require carve-out programs (which are specialized managed care organizations that administer the behavioral health benefits for an insurance plan) to comply with parity requirements in the same manner that the insurer would have been required.

Four other provisions in the health care reform proposals affect the behavioral health care system. First, there are provisions that aim to address the issue of behavioral health provider shortage by providing for the establishment of grant programs to train and educate such providers. Second, some provisions aim to address the issue of affordability and lack of coordination of behavioral health care through the co-location of primary and specialty care services with behavioral health services. Third, some provisions aim to address research needs in specialty areas of mental health care by authorizing studies on postpartum depression. Fourth, a provision in the House bill would establish federally qualified behavioral health centers.

Date of Report: December 15, 2009
Number of Pages: 11
Order Number: R40847
Price: $29.95
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