This report, released October 6 by the Congressional Research Service (CRS), analyzes the provisions in national health care reform legislation in the House (H.R. 3200) and the Senate Health, Education, Labor and Pensions Committee (S. 1679) that affect behavioral health care, including those provisions which interact with 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).

From the executive summary:

Under H.R. 3200, which was ordered to be reported as amended by the House Committees on Ways and Means, Energy and Commerce, and Education and Labor, 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 HELP bill, S. 1679. 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 the parity requirements in the same manner that the insurer would have been required.

Three 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 establishment of federally qualified behavioral health centers and co-location of primary and specialty care services with behavioral health services. Third, a provision in the Energy and Commerce version of H.R. 3200 aims to address research needs in specialty areas of mental health care by authorizing studies on postpartum depression. 

Congressional Research Service. (2009). Behavioral Health Care in H.R. 3200 and S. 1679. Sundararaman, Ramya. 

The report is available from the National Council for Community Behavioral Healthcare here: http://www.thenationalcouncil.org/galleries/policy-file/Behavioral%20Health%20Care%20in%20HR%203200%20and%20S%201679.pdf 

This study examines M/SU parity laws and their potential effect on out-of-pocket mental health treatment costs.  The study found modest yet important variation in out-of-pocket burden across states but note that prescription drugs account for nearly two-thirds of out-of-pocket spending and fall largely outside the scope of federal M/SU parity laws.  The authors conclude that M/SU parity laws will do little to reduce the observed burden or inter-state variation.  

Zuvekas, S. H., & Meyerhoefer, C. D. (2009). State variations in the out-of-pocket spending burden for outpatient mental health treatment. Health Affairs, 28(3), 713-22. DOI: 10.1377/hlthaff.28.3.713 http://content.healthaffairs.org/cgi/content/abstract/28/3/713 

Authors: Samuel H. Zuvekas, Chad D. Meyerhoefer.

This perspectives article considers the Mental Health Parity and Addiction Equity Act of 2008 and highlights the need for clear regulations and education regarding the costs of untreated M/SU conditions.  The authors suggest using the new law to reinforce the centrality of mental health care within the overall health care system and as a curricula piece of health care reform. 

Shern, D. L., K. K. Beronio, et al. (2009). After parity--what's next. Health Affairs, 28(3), 660-2. DOI: 10.1377/hlthaff.28.3.660 http://content.healthaffairs.org/cgi/content/abstract/28/3/660 

Authors: David L. Shern, Kirsten K. Beronio, Henry T. Harbin.

This white paper by Milliman Inc. analyzes the Mental Health Parity and Addiction Equity Act of 2008, focusing on effects of the parity legislation on individuals, health care plans, managed behavioral health care organizations (MHBOs) and other key stakeholders. 

Download the white paper from Milliman: http://www.milliman.com/expertise/healthcare/publications/rr/pdfs/preparing-parity-investing-mental-WP05-01-09.pdf 

This perspectives article examines implementation challenges surrounding the Mental Health Parity and Addiction Equity Act of 2008.  the author notes that unique features of M/SU care will pose challenges in aligning benefits with general health care.  

Dixon, K. (2009). Implementing mental health parity: the challenge for health plans. Health Affairs, 28(3), 663-5. DOI: 10.1377/hlthaff.28.3.663 http://content.healthaffairs.org/cgi/content/abstract/28/3/663 

Author: Keith Dixon

In 2004-5 two-thirds of primary care physicians (PCPs) reported being unsuccessful at obtaining mental health services for patients at a rate twice as high as for other services.  PCPs cited shortages of mental health care providers, health plan barriers, and lack of coverage or inadequate coverage.  The author concludes that implementing mental health parity will reduce some but not all of the barriers to care. 

Cunningham, P. J. (2009). Beyond parity: primary care physicians' perspectives on access to mental health care. Health Affairs, 28(3), w490-501. DOI: 10.1377/hlthaff.28.3.w490 http://content.healthaffairs.org/cgi/content/abstract/28/3/w490 

Author: Peter J. Cunningham