Rosalynn Carter's mental-health dream realized with new rule

'Parity' required with physical health coverage

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ATLANTA — Rosalynn Carter has tried for decades to convince the world that mental illness is no different from physical illness. On Friday, Carter's long-held conviction became part of federal law.

U.S. Health and Human Services Secretary Kathleen Sebelius, speaking at the former first lady's mental health symposium in Atlanta, announced a new federal rule requiring insurers to cover mental illness and addiction in the same way they cover other health problems.

Congress passed the Mental Health Parity and Addiction Equity Act in 2008. But until now, the government had not written detailed regulations in support of the law. The long-awaited pages of fine print recognized the completion of a public policy ideal for Carter.

"I often have said that if insurance covered mental illness the way other diseases like cancer or diabetes are covered, there would be less stigma against these diseases, and we all would benefit from healthier mothers, brothers, workers and friends," Carter said.

Advocates say the parity requirements, combined with new requirements for mental health coverage under the Affordable Care Act, represent a profound cultural shift for the nation.

"This has been a dream of Mrs. Carter's for over 20 years," said Dr. Thomas H. Bornemann, director of the Carter Center's Mental Health Program. "It has been her No. 1 public policy goal. I can't tell you what meaning that gives to her and to all of us at the Carter Center that after this long road — we got it."

Since the passage of the Parity Act in 2008, most health plans started making changes to achieve compliance. But the rules will spell out exactly what is required to abide by the law. Attorneys, consultants and advocates said they needed to closely study the regulations to determine exactly how they might change the experience of patients seeking mental health and substance abuse treatment.

The rule is supposed to guarantee that insurers won't charge more for co-pays, deductibles and visits for mental health or addiction treatment. Among its provisions, the government said:

• Ensuring that parity applies to mental health treatment that may or may not be covered under current policies, including residential treatment and intensive outpatient care. These are especially important in the treatment of addiction.

• Requiring greater transparency by health plans.

• Clarifying that parity applies to all parts of the plan, including geographic limits, facility-type limits and network adequacy.

"This is excellent news," said Dr. Nadine Kaslow, a professor at the Emory University School of Medicine and the president-elect of the American Psychological Association. "It's one thing to say there's parity. It's another thing to put concrete realities behind that."

Kaslow said the rule should make sure that insurers offer more robust lists of health care providers to treat mental illness and addiction, so that patients do not find that all of the providers on a list are booked up and not accepting new patients. "This should provide real and much quicker access to care," she said.

As Carter noted, Kaslow and others said the rule will reduce the stigma associated with seeking treatment.

"It's just a wonderful recognition that mental health is a big issue," said Ellyn Jeager, director of public policy and advocacy at Mental Health America of Georgia. "Voices are being heard."

The new rule was the last in a long series of executive actions that President Barack Obama took in response to the massacre of schoolchildren in Newtown, Conn., last December. The adoption of the rule could mean, among other things, that mentally ill people get treatment that helps them avoid turning violent, administration officials said.

Obama and Vice President Joe Biden developed a plan to reduce mass shootings in the wake of the Newtown shootings, after Obama concluded he could not get gun control legislation through Congress.