Oregonians Gain Benefit Of Parity MH Coverage

Oregon group health plans will now have to provide the same level of coverage for mental health care, including substance abuse, as they do for treatment of other medical illnesses when a new state law goes into effect January 1, 2007.

Mental health care advocates described the parity law—the first for Oregon—as the conclusion of a long fight that resulted in one of the more comprehensive state parity laws in the nation.

“This was the culmination of almost 10 years of work by the Oregon Psychiatric Association (OPA) and its allies,” said Paula Johnson, deputy director of state affairs in the APA Department of Government Relations.

The Oregon Senate passed the parity law by a 24-5 vote, and the Oregon House of Representatives by a 59-1 vote. Gov. Ted Kulongoski (D) signed it in August.

The federal Mental Health Parity Act prohibits discriminatory annual and lifetime dollar caps for mental health benefits as compared with other medical and surgical benefits. The Oregon law is much broader; it requires insurers to provide coverage for treatment of chemical dependency, including alcoholism, and “mental and nervous conditions” at the same level as, and subject to limitations no more restrictive than, those imposed on coverage or reimbursement of expenses arising from treatment for other medical conditions. It also stipulates that deductibles and coinsurance for inpatient or outpatient treatment may not be greater than those under the policy for the treatment of other medical conditions.

In other states, some health plans have been accused of circumventing a state's mental health parity law by using stricter criteria for the determination of medical necessity for treatment of psychiatric illnesses than for other illnesses. While the Oregon law permits coverage of eligible expenses to be limited to treatment that is medically necessary, plans must use the same methods of determination as they do for other medical conditions.

Moreover, unlike some other parity laws, this one requires that all businesses offering group plans comply; that is, it does not exempt businesses with 50 employees or fewer, according to John McCulley, executive secretary of the OPA.

The law's 2007 implementation date is intended to give health insurers time to prepare to meet the coverage requirements of the new law.

State health officials will decide which psychiatric conditions, if any, will be restricted under the law, according to Bruce Goldberg of the Office for Oregon Health Policy and Research.

Among the law's practical implications are an end to limits on the number of visits to mental health practitioners and the length of inpatient treatment, not otherwise limited for other medical conditions. The level of mental health coverage among group health insurance beneficiaries will depend on the level of general health coverage provided in their health insurance policies. If a policy offers only basic general health coverage, the insurer will have to provide only basic mental health coverage.

Oregon is the 36th state to require parity, which could affect an estimated 1.3 million Oregonians enrolled in group health insurance plans, according to state figures. Coverage will not change for state employees and low-income families enrolled in the state's Medicaid program, the Oregon Health Plan, which already provides parity for mental health benefits. The law will not provide coverage to the more than 600,000 Oregonians who lack health insurance.

Status of Parity in Other States

Other states that have enacted parity laws have found that insurance premiums have increased by no more than 2 percent, according to advocates of the Oregon measure.

Iowa Gov. Tom Vilsack (D) signed a bill in May that requires all health insurance plans to provide coverage for “biologically based” mental illnesses. The law applies to insurance plans issued to businesses with more than 50 full-time employees on at least half of the employer's working days in the previous calendar year and to plans offered by small employers that already provide some mental illness treatment coverage.

Conditions included in the law are schizophrenia, bipolar disorders, major depressive disorders, schizoaffective disorders, obsessive-compulsive disorders, pervasive developmental disorders, and autistic disorders. The law establishes parity requirements for aggregate annual and lifetime limits, deductibles, and coinsurance and copayments.

A temporary Illinois law, passed in 2001, which mandated parity insurance coverage for biologically based mental illnesses, was made permanent under a law signed on August 2 by Gov. Rod Blagojevich (D).

In New York, efforts to get parity legislation passed in this session came to an end in August. While the New York State Assembly passed a bill in June to provide parity in insurance coverage for mental illnesses, including chemical dependency, the Senate adjourned without taking up the bill. Each year since 2003, the bill has passed the Democratic-controlled state Assembly only to be defeated in the Republican-controlled Senate amid concerns that the measure would increase health care premiums for individuals and businesses.

The text of the Oregon bill (SB 1) is posted at<http://landru.leg.state.or.us/05reg/measures/sb0001.dir/sb0001.en.html>.▪