New Limits On Mental Health Care May Violate Federal Law

New restrictions on mental health care aimed at bringing down costs may be violating a federal mental health parity law, reports Kay Lazar in The Boston Globe today.

The new regulations imposed by some employers — including extensive pre-authorization rules involving frequent, in-depth progress reports on patients — are "excessive" and not in keeping with a 2008 law that requires mental health coverage to be offered at the same level of service as other types of medical care, argue some legal advocates. The Globe details the problem:

At issue is the growing practice of requiring therapists to undergo lengthy and repeated phone interviews about their patients’ progress before the insurance company will approve further treatment. According to patients and therapists interviewed by the Globe, the reviews have established tougher criteria for additional visits and have been burdensome and intimidating. That has sometimes led to curtailed treatment and protracted appeals.

Among those feeling the squeeze are state and municipal employees who get their insurance through the Group Insurance Commission, a quasi-state agency that provides mental health coverage for more than 100,000 workers and their families.

The commission, facing double-digit increases in its mental health insurance costs, changed its rules last year and now requires therapists who are not in the commission’s roster of approved specialists to justify, usually through lengthy telephone reviews, a patient’s need for continued treatment after every 10 sessions. Previously, the commission simply required the therapists to regularly fax the insurer a progress report.

Still, a legal challenge might soon arise, Lazar writes:

“We are seeing what seem to be excessive preauthorization and other reviews that we don’t typically see for other medical services,’’ said Matt Selig, executive director of Health Law Advocates, a public interest law firm based in Boston.

Selig said his organization is compiling examples to determine whether to file a legal challenge on behalf of some patients and therapists.

This program aired on May 17, 2010. The audio for this program is not available.

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Rachel Zimmerman Reporter
Rachel Zimmerman previously reported on health and the intersection of health and business for WBUR. She is working on a memoir about rebuilding her family after her husband’s suicide. 



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