Ohio passed a limited version of parity legislation in 2006, well in advance of many other states and the federal government. Shortly after, Congress passed the Mental Health Parity and Addiction Equity Act of 2008, which President George W. Bush subsequently signed into law.
The law is meant to ensure that insurance coverage for mental health and substance use disorder treatment does not differ from coverage for treatment of any other physical disorder in terms of limits on out-patient treatment, in-patient treatment, emergency care, or prescription medication.
Some health plans are exempt from the law, but those exemptions are not common after Congress strengthened federal parity laws in 2010. Initially, there was concern that parity would lead to unsustainable costs for health plans. However, most have been able to manage parity implementation, though some have seen slight increases.
Despite the law and the financial neutrality of parity, differences still exist between the rendering of a “medical benefit” and a “behavioral health benefit.” Patients frequently find that access to mental health and addiction providers is much more difficult than access to other medical specialists, that hospital access is difficult due to lack of available beds, and that emergency services are not tailored to meet their needs.
Providers indicate that third-party payers require prior authorization and continued authorizations for therapy, medication, or hospitalization in excess of that required for physical medical conditions.
They also describe vague and proprietary criteria that are not always shared with those rendering care and may not be in the best interest of patients.
Additionally, despite increasing demand for services, the disparity between compensation for mental health and addiction services and other medical services has led some hospitals and other providers to reduce mental health and addiction treatment capacity in favor of more lucrative “medical” service lines, leading to even more restricted access to care. While the law has helped, true parity does not exist.
To address parity in Ohio, the RecoveryOhio Advisory Council recommends:
5. Alignment With the Mental Health Parity and Addiction Equity Act
Align Ohio laws with the federal Mental Health Parity and Addiction Equity Act.
6. State Parity Coordination and Enforcement
Coordinate across Ohio’s state agencies to disseminate a concise definition of parity rights, enhance transparency, and promote a feedback process to allow continuous improvement with clear benchmarks. The Ohio Department of Insurance should work with state departments, such as the Ohio Departments of Medicaid, Mental Health and Addiction Services, Health, Administration Services, and other appropriate departments, boards, and commissions to achieve this goal. State agencies should also look at enforcement opportunities and their role in consumer protection.
7. Parity Education and Training
Educate patients, families, employers, and professionals who serve the public — for example hospital staff, social workers, and public health workers — to ensure understanding of insurance coverage rights and how to seek support with parity enforcement. Require that patients seeking treatment receive a notification of their parity rights similar to notifications regarding the Health Insurance Portability and Accountability Act (HIPAA).