State Parity:
Ohio’s
“biologically based” mental health parity bill, passed in the 126th
General Assembly, ends discrimination for a list of “biologically based
mental illness” diagnoses. It also requires that insurers cover the
diagnosis, care and treatment of these disorders in the same manner as
other “basic health care services.” The bill defines “biologically
based mental illnesses” as: schizophrenia, panic disorder, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders and obsessive-compulsive disorder.
The
terms of these diagnoses are defined in the most recent edition of the
“Diagnostic and Statistical Manual of Mental Disorders” published by
the American Psychiatric Association. (The most recent version is the
DSM-IV-TR, published in 2000).
According
to the Legislative Service Commission’s Final Analysis, "The law
specifies that its equal benefits mandate applies to all coverages and
terms and conditions of a policy ...coverage including, but not limited
to, coverage of impatient hospital services, outpatient services and
medication; maximum lifetime benefits; co-payments; and individual and
family deductibles."
Read the language of the bill and Q&A from the Ohio Department of Insurance.
Background
OPA
saw many difficulties with this bill and therefore remained neutral
during the hearings. Some of the difficulties are listed below.
Problems with the Law (OPA
saw many difficulties with this bill and therefore remained neutral
during the hearings. Some of the difficulties are listed below.)
1. If a company is self-insured, it does not have to obey this law.
2.
Many significant mental illnesses (e.g. post traumatic stress disorder)
are not covered by this law. Therefore, other medical disorders (now
called “non-biologically based” by some insurers) are subject to lower
yearly and lifetime limits, higher deductibles and higher co-pays.
3. Most of the diagnoses that children are assigned are not covered in the “biologically based list.”
4. There is no scientific agreement of which disorders are “biologically based.
5. The law does not specify the DSM codes for the disorders, it only names them.
6. If the insurance policy allows higher copays for “specialties” psychology may be defined as a specialty.
Additional Resources:
Ohio Department of Insurance Parity Toolkit
Federal Parity:
The President signed the Paul Wellstone
and Pete Domenici Mental Health Parity and Addiction Equity Act into
law in October 2008 in a tremendous victory for psychologists and the
patients they serve. The Act becomes effective January 2010.
Click below for more information on the federal parity law:
The Wellstone-Domenici Mental Health Parity Act of 2008: Psychologist Q&A
Bachman PowerPoint
“Understanding the New Parity Law”
“How Does the New Mental
Health Parity Law Affect My Insurance Coverage?” a consumer FAQ by APA
An
Employer’s Guide to the Mental Health Parity and Addiction Equity Act, by Ron
Bachman
Q&A on Wellstone and Domenici Act by APA
Summary of
Wellstone-Domenici Act by APA
Still confused? Contact Dr. Bobbie Celeste with questions.